Journal Article > ResearchFull Text
PLOS One. 2014 September 24; Volume 9 (Issue 9); DOI:10.1371/journal.pone.0108591
Horter SCB, Stringer B, Venis S, du Cros PAK
PLOS One. 2014 September 24; Volume 9 (Issue 9); DOI:10.1371/journal.pone.0108591
In 2011, Médecins Sans Frontières (MSF) established a blogging project, "TB&Me," to enable patients with multidrug-resistant tuberculosis (MDR-TB) to share their experiences. By September 2012, 13 MDR-TB patients had blogged, either directly or with assistance, from the UK, Australia, Philippines, Swaziland, Central African Republic, Uganda, South Africa, India, and Armenia. Due to the lack of research on the potential for social media to support MDR-TB treatment and the innovative nature of the blog, we decided to conduct a qualitative study to examine patient and staff experiences. Our aim was to identify potential risks and benefits associated with blogging to enable us to determine whether social media had a role to play in supporting patients with MDR-TB.
Conference Material > Abstract
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/b641-d608
INTRODUCTION
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Conference Material > Slide Presentation
Ali Dubad B, Baertlein L, Piening T, Chindong I, Sahelie B, et al.
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/8bp2-4234
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.
Protocol > Research Study
Verputten M, Siddiqui R, Gray NSB, Casimir CF, Finaldi P, et al.
2018 July 1
2 Research question and objectives
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
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.
Journal Article > ResearchFull Text
BMC Public Health. 2018 February 13; Volume 18 (Issue 1); DOI:10.1186/s12889-018-5158-6
Caleo GNC, Duncombe J, Jephcott F, Lokuge K, Mills C, et al.
BMC Public Health. 2018 February 13; Volume 18 (Issue 1); DOI:10.1186/s12889-018-5158-6
Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone.
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.
Protocol > Research Study
van der Heijden J, Stringer B, Gray NSB, Kalon S, Dada M, et al.
2018 July 1
Objectives
This study aims to provide a better understanding of community perceptions toward health and health services in order to inform programme strategies:
• Describe community and local-level perspectives and opinions on health care provision;
• Document gaps, barriers and influences that impact access and acceptance of health care;
• Contribute to best practice and development of health policy for this population
This study aims to provide a better understanding of community perceptions toward health and health services in order to inform programme strategies:
• Describe community and local-level perspectives and opinions on health care provision;
• Document gaps, barriers and influences that impact access and acceptance of health care;
• Contribute to best practice and development of health policy for this population
Conference Material > Abstract
Ali Dubad B, Baertlein L, Piening T, Chindong I, Sahelie B, et al.
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/s9dr-mf76
INTRODUCTION
The Somali Region is one of the least developed regions of Ethiopia, with low coverage of healthcare services and recurrent disease outbreaks, floods, and malnutrition emergencies. MSF has been providing medical assistance in the Doolo Zone, Somali Region, since 2007. Following multiple disease outbreaks in 2017, MSF shifted focus to work primarily on early outbreak detection and provision of a timely response. In 2019, MSF established a “Tea Team surveillance team”; this combines health facility data with that from community indicator- and event-based surveillance systems. Data are collected from 32 locations (17 surveillance only and 15 non-permanent mobile clinic sites), as well as alerts from other actors in Doolo Zone. We aimed to evaluate the usefulness of the data generated by these different components.
METHODS
We used a mixed methods approach. Description of the surveillance system, quantitative analysis of retrospective data between February 2019 and January 2021, and focus group discussions were the main methods used to evaluate usefulness, acceptability, and other surveillance attributes. Quantitative analyses were done using R software (R Core Team, 2014) while qualitative data analysis was performed with NVivo software (QSR International Pty Ltd, Australia).
ETHICS
Permission to conduct the study was obtained from the Somali Regional Health Bureau. This study was approved by the MSF Ethics Review Board.
RESULTS
Over 1200 signals were reported to the Tea Team surveillance system over the evaluation period, with the majority being reported via the community event-based surveillance (CEBS) component. There were a total of 31 responses conducted between February 2019 and January 2021. 22 (84.6%) originated from CEBS system signals, one (3.8%) was from the community indicator-based surveillance (CIBS) system, 2 (7.7%) were from health facility indicator-based surveillance (HFIBS), and 6 (23.1%) came from other event-based surveillance systems. Most responses were triggered by population movements, suspected measles, and suspected acute watery diarrhoea. No responses arose from acute jaundice syndrome signals. MSF staff found the “Tea Team surveillance system” to have higher acceptability in non-emergency situations, but indicated lower acceptability during a crisis, due to data processing times and rigidity of the HFIBS online database. The surveillance system has complex data management procedures leading to potential underreporting of signals and difficulties with routine data quality monitoring. Project staff considered the CEBS and CIBS components to be more flexible than HFIBS. The system was sufficiently flexible to integrate with Covid-19 surveillance.
CONCLUSION
The Tea Team surveillance system is a comprehensive and useful system to detect and respond to public health events in a pastoralist population. Simplification of the surveillance system and greater standardisation of the data management processes will increase the utility of the system.
CONFLICTS OF INTEREST
None declared
The Somali Region is one of the least developed regions of Ethiopia, with low coverage of healthcare services and recurrent disease outbreaks, floods, and malnutrition emergencies. MSF has been providing medical assistance in the Doolo Zone, Somali Region, since 2007. Following multiple disease outbreaks in 2017, MSF shifted focus to work primarily on early outbreak detection and provision of a timely response. In 2019, MSF established a “Tea Team surveillance team”; this combines health facility data with that from community indicator- and event-based surveillance systems. Data are collected from 32 locations (17 surveillance only and 15 non-permanent mobile clinic sites), as well as alerts from other actors in Doolo Zone. We aimed to evaluate the usefulness of the data generated by these different components.
METHODS
We used a mixed methods approach. Description of the surveillance system, quantitative analysis of retrospective data between February 2019 and January 2021, and focus group discussions were the main methods used to evaluate usefulness, acceptability, and other surveillance attributes. Quantitative analyses were done using R software (R Core Team, 2014) while qualitative data analysis was performed with NVivo software (QSR International Pty Ltd, Australia).
ETHICS
Permission to conduct the study was obtained from the Somali Regional Health Bureau. This study was approved by the MSF Ethics Review Board.
RESULTS
Over 1200 signals were reported to the Tea Team surveillance system over the evaluation period, with the majority being reported via the community event-based surveillance (CEBS) component. There were a total of 31 responses conducted between February 2019 and January 2021. 22 (84.6%) originated from CEBS system signals, one (3.8%) was from the community indicator-based surveillance (CIBS) system, 2 (7.7%) were from health facility indicator-based surveillance (HFIBS), and 6 (23.1%) came from other event-based surveillance systems. Most responses were triggered by population movements, suspected measles, and suspected acute watery diarrhoea. No responses arose from acute jaundice syndrome signals. MSF staff found the “Tea Team surveillance system” to have higher acceptability in non-emergency situations, but indicated lower acceptability during a crisis, due to data processing times and rigidity of the HFIBS online database. The surveillance system has complex data management procedures leading to potential underreporting of signals and difficulties with routine data quality monitoring. Project staff considered the CEBS and CIBS components to be more flexible than HFIBS. The system was sufficiently flexible to integrate with Covid-19 surveillance.
CONCLUSION
The Tea Team surveillance system is a comprehensive and useful system to detect and respond to public health events in a pastoralist population. Simplification of the surveillance system and greater standardisation of the data management processes will increase the utility of the system.
CONFLICTS OF INTEREST
None declared