Journal Article > ResearchFull Text
JAC Antimicrob Resist. 2024 March 5; Volume 6 (Issue 2); dlae024.; DOI:10.1093/jacamr/dlae024
Almehdar H, Yousef N, van den Boogaard W, Haider A, Kanapathipillai R, et al.
JAC Antimicrob Resist. 2024 March 5; Volume 6 (Issue 2); dlae024.; DOI:10.1093/jacamr/dlae024
BACKGROUND
Antimicrobial resistance (AMR) is an urgent global health concern, especially in countries facing instability or conflicts, with compromised healthcare systems. Médecins Sans Frontières (MSF) established an acute trauma hospital in Aden, Yemen, treating mainly war-wounded civilians, and implemented an antimicrobial stewardship (AMS) programme. This study aimed to describe clinical characteristics and identify antibiotic susceptibility patterns representative of patients treated with antibiotics.
METHODS
Retrospective cross-sectional study using routinely collected data from all patients treated with antibiotics in the MSF-Aden Acute Trauma hospital between January 2018 and June 2021. Routine clinical data from patients’ files was entered into an AMS electronic database and microbiological data were entered into WHONET. Both databases were imported and merged in REDCap and analysed using RStudio.
RESULTS
Three hundred and sixty-three of 481 (75%) included patients were injured by violence-related trauma. Most were men aged 19–45 years (n = 331; 68.8%). In total, 598 infections were diagnosed and treated. MDR organisms were identified in 362 (60.5%) infections in 311 (65%) patients. Skin and soft-tissue infections (SSTIs) (n = 143; 24%) were the most common, followed by osteomyelitis (n = 125; 21%) and intra-abdominal-infections (IAIs) (n = 116; 19%), and 111 (19%) secondary bloodstream infections were identified. Escherichia coli was the most frequently identified pathogen, causing IAI (n = 87; 28%) and SSTI (n = 43; 16%), while Staphylococcus aureus caused mainly osteomyelitis (n = 84; 19%). Most Gram-negatives were ESBL producers, including E. coli (n = 193; 81.4%), Klebsiella pneumoniae (n = 72; 77.4%) and Enterobacter cloacae (n = 39; 50%) while most S. aureus were methicillin resistant (n = 93; 72.6%).
CONCLUSIONS
High rates of MDR were found. This information will facilitate a comprehensive review of the empirical antibiotic treatment guidelines.
Antimicrobial resistance (AMR) is an urgent global health concern, especially in countries facing instability or conflicts, with compromised healthcare systems. Médecins Sans Frontières (MSF) established an acute trauma hospital in Aden, Yemen, treating mainly war-wounded civilians, and implemented an antimicrobial stewardship (AMS) programme. This study aimed to describe clinical characteristics and identify antibiotic susceptibility patterns representative of patients treated with antibiotics.
METHODS
Retrospective cross-sectional study using routinely collected data from all patients treated with antibiotics in the MSF-Aden Acute Trauma hospital between January 2018 and June 2021. Routine clinical data from patients’ files was entered into an AMS electronic database and microbiological data were entered into WHONET. Both databases were imported and merged in REDCap and analysed using RStudio.
RESULTS
Three hundred and sixty-three of 481 (75%) included patients were injured by violence-related trauma. Most were men aged 19–45 years (n = 331; 68.8%). In total, 598 infections were diagnosed and treated. MDR organisms were identified in 362 (60.5%) infections in 311 (65%) patients. Skin and soft-tissue infections (SSTIs) (n = 143; 24%) were the most common, followed by osteomyelitis (n = 125; 21%) and intra-abdominal-infections (IAIs) (n = 116; 19%), and 111 (19%) secondary bloodstream infections were identified. Escherichia coli was the most frequently identified pathogen, causing IAI (n = 87; 28%) and SSTI (n = 43; 16%), while Staphylococcus aureus caused mainly osteomyelitis (n = 84; 19%). Most Gram-negatives were ESBL producers, including E. coli (n = 193; 81.4%), Klebsiella pneumoniae (n = 72; 77.4%) and Enterobacter cloacae (n = 39; 50%) while most S. aureus were methicillin resistant (n = 93; 72.6%).
CONCLUSIONS
High rates of MDR were found. This information will facilitate a comprehensive review of the empirical antibiotic treatment guidelines.
Journal Article > ResearchFull Text
Public Health Action. 2024 March 1; Volume 14 (Issue 1); 14-19.; DOI:10.5588/pha.23.0022
Tsorou C, Williams A, van den Boogaard W, Staderini N, Repetto E, et al.
Public Health Action. 2024 March 1; Volume 14 (Issue 1); 14-19.; DOI:10.5588/pha.23.0022
SETTING
Sexually transmitted infections (STIs) can impact individuals of any demographic. The most common pathogens causing STIs are Chlamydia trachomatis, Neisseria gonorrhea and Trichomonas vaginalis; these can be treated with specific antibiotics.
OBJECTIVE
To compare the GeneXpert CT/NG test-and-treat algorithm to the syndromic approach algorithm and their impact on antibiotic prescription for gonorrhoea and chlamydia STIs.
DESIGN
A retrospective observational study on women aged ≥18 years who accessed the Médecins Sans Frontières Day Care Centre in Athens with complaints related to urogenital infections between January 2021 and March 2022. Women with abnormal vaginal discharge, excluding clinically diagnosed candidiasis, were eligible for Xpert CT/NG testing.
RESULTS
Of the 450 women who accessed care, 84 were eligible for Xpert CT/NG testing, and only one was positive for chlamydia, therefore resulting in saving 81 doses of ceftriaxone and azithromycin, and 19 doses of metronidazole. The cost of Xpert CT/NG testing, including treatment was €4,606.37, while full antibiotic treatment would have costed €536.76.
CONCLUSION
The overall cost of the Xpert CT/NG test-and-treat algorithm was higher than the syndromic approach. However, quality of care should be weighed against the potential benefits of testing and syndromic treatment to determine the best option for each patient; we therefore advocate for decreasing the costs.
Sexually transmitted infections (STIs) can impact individuals of any demographic. The most common pathogens causing STIs are Chlamydia trachomatis, Neisseria gonorrhea and Trichomonas vaginalis; these can be treated with specific antibiotics.
OBJECTIVE
To compare the GeneXpert CT/NG test-and-treat algorithm to the syndromic approach algorithm and their impact on antibiotic prescription for gonorrhoea and chlamydia STIs.
DESIGN
A retrospective observational study on women aged ≥18 years who accessed the Médecins Sans Frontières Day Care Centre in Athens with complaints related to urogenital infections between January 2021 and March 2022. Women with abnormal vaginal discharge, excluding clinically diagnosed candidiasis, were eligible for Xpert CT/NG testing.
RESULTS
Of the 450 women who accessed care, 84 were eligible for Xpert CT/NG testing, and only one was positive for chlamydia, therefore resulting in saving 81 doses of ceftriaxone and azithromycin, and 19 doses of metronidazole. The cost of Xpert CT/NG testing, including treatment was €4,606.37, while full antibiotic treatment would have costed €536.76.
CONCLUSION
The overall cost of the Xpert CT/NG test-and-treat algorithm was higher than the syndromic approach. However, quality of care should be weighed against the potential benefits of testing and syndromic treatment to determine the best option for each patient; we therefore advocate for decreasing the costs.
Journal Article > ResearchFull Text
Public Health Action. 2023 August 1; Volume 13 (Issue 2(Suppl 1)); 13-18.; DOI:10.5588/pha.23.0004
Huyghe S, Telo S, Danwesse E, Ali E, van den Boogaard W, et al.
Public Health Action. 2023 August 1; Volume 13 (Issue 2(Suppl 1)); 13-18.; DOI:10.5588/pha.23.0004
CONTEXTE
Le taux de mortalité maternelle reste élevé (882/100 000 naissances) en République Centrafricaine (RCA), du fait de la survenue de fréquentes complications obstétricales. Médecins Sans Frontières y soutient une maternité de référence à la capitale, Bangui.
OBJECTIFS
Décrire la prévalence, les facteurs associés et la létalité, de l’une des plus sévères, la rupture utérine (RU), ainsi que l’influence d’un antécédent de chirurgie utérine.
MÉTHODES
Ceci est une étude transversale sur des données collectées rétrospectivement entre janvier 2018 et décembre 2021 pour les femmes accouchées d’un nouveau-né plus de 1 000 g.
RÉSULTATS
Sur 38 782 accouchements, 229 (0,6%) de RU étaient enregistrés. Les facteurs associés à la RU étaient : une parité =5 (ORb 7,5 ; IC 95% 4,6–12,2), une présentation fœtale non occipitale (ORb 2,8 ; IC 95% 2,1–3,7) et une macrosomie (OR 4 ; IC 95% 2,6–6,4). La létalité était de 4,4% et la mortinatalité de 64%. La RU était survenue sur utérus non cicatriciel chez 150 (66,1%) femmes. L’issue était plus défavorable en cas de survenue sur utérus non cicatriciel que cicatriciel avec plus de décès maternel (6% vs 0% ; P = 0,023) et un Apgar du nouveau-né < 2 (69,1% vs 45,8% ; P < 0,001).
CONCLUSION
La RU reste un problème majeur de santé maternelle et périnatale en RCA et des efforts sont nécessaires pour détecter précocement les facteurs de risque et d’augmenter la couverture des Soins Obstétricaux et Néonataux d’Urgence Complets.
Le taux de mortalité maternelle reste élevé (882/100 000 naissances) en République Centrafricaine (RCA), du fait de la survenue de fréquentes complications obstétricales. Médecins Sans Frontières y soutient une maternité de référence à la capitale, Bangui.
OBJECTIFS
Décrire la prévalence, les facteurs associés et la létalité, de l’une des plus sévères, la rupture utérine (RU), ainsi que l’influence d’un antécédent de chirurgie utérine.
MÉTHODES
Ceci est une étude transversale sur des données collectées rétrospectivement entre janvier 2018 et décembre 2021 pour les femmes accouchées d’un nouveau-né plus de 1 000 g.
RÉSULTATS
Sur 38 782 accouchements, 229 (0,6%) de RU étaient enregistrés. Les facteurs associés à la RU étaient : une parité =5 (ORb 7,5 ; IC 95% 4,6–12,2), une présentation fœtale non occipitale (ORb 2,8 ; IC 95% 2,1–3,7) et une macrosomie (OR 4 ; IC 95% 2,6–6,4). La létalité était de 4,4% et la mortinatalité de 64%. La RU était survenue sur utérus non cicatriciel chez 150 (66,1%) femmes. L’issue était plus défavorable en cas de survenue sur utérus non cicatriciel que cicatriciel avec plus de décès maternel (6% vs 0% ; P = 0,023) et un Apgar du nouveau-né < 2 (69,1% vs 45,8% ; P < 0,001).
CONCLUSION
La RU reste un problème majeur de santé maternelle et périnatale en RCA et des efforts sont nécessaires pour détecter précocement les facteurs de risque et d’augmenter la couverture des Soins Obstétricaux et Néonataux d’Urgence Complets.
Journal Article > ResearchFull Text
Public Health Action. 2023 August 1; Volume 13 (Issue 2(Suppl 1)); 1-6.; DOI:10.5588/pha.23.0008
Baptiste SL, van den Boogaard W, Letoquart JP, NDong JG, Jonacé G, et al.
Public Health Action. 2023 August 1; Volume 13 (Issue 2(Suppl 1)); 1-6.; DOI:10.5588/pha.23.0008
CONTEXTE
Les traumatismes abdominaux (TA) semblent fréquents en Haïti confronté à des violences socio-politiques récurrents.
OBJECTIF
Etudier les patients admis pour TA au centre traumatologie Médecins Sans Frontières (MSF) Tabarre (Port-au-Prince), et les circonstances de survenue.
TYPE D’ETUDE
Ceci est une étude transversale sur des données rétrospectives de Janvier 2020 à Décembre 2021.
RÉSULTATS
Sur 3 211 patients admis pour traumatisme, 541 (17,3%) avaient un TA, dont 500 (91,4%) en lien avec des événements socio-politiques. Leur âge médian était de 30 ans (intervalle interquartile [IQR] 23–38) ; 429 (85,8%) étaient masculin. Une blessure par balle était notée chez 371 (74,2%). La distance médiane entre le lieu de violence et l’hôpital était de 11 km (IQR 7–15) ; cependant, 9 (1,8%) étaient venus dans l’heure après le traumatisme ; la transfusion était non faite ou insuffisante chez 169 (33,8%). Une issue défavorable (décès, référence, sortie contre-avis médical) était notée chez 57 (11,4%), avec 8,0% de décès. L’instabilité politique était la principale cause de violence. Une issue défavorable était associée à une transfusion insuffisante (rapport de risque [RR] 2,4 ; IC 95% 1,4–4,3 ; P = 0,006) ou à une blessure par balle (RR 2,4 ; IC 95% 1,1–5,2 ; P = 0,002).
CONCLUSION
Les TA par balle étaient fréquents durant la période des évènements socio-politiques 2020–2021. Le manque de produits sanguins a eu un impact négatif sur l’issue des patients. Les mesures de sécurité et la collecte de sang doivent toujours être maintenues et renforcées.
Les traumatismes abdominaux (TA) semblent fréquents en Haïti confronté à des violences socio-politiques récurrents.
OBJECTIF
Etudier les patients admis pour TA au centre traumatologie Médecins Sans Frontières (MSF) Tabarre (Port-au-Prince), et les circonstances de survenue.
TYPE D’ETUDE
Ceci est une étude transversale sur des données rétrospectives de Janvier 2020 à Décembre 2021.
RÉSULTATS
Sur 3 211 patients admis pour traumatisme, 541 (17,3%) avaient un TA, dont 500 (91,4%) en lien avec des événements socio-politiques. Leur âge médian était de 30 ans (intervalle interquartile [IQR] 23–38) ; 429 (85,8%) étaient masculin. Une blessure par balle était notée chez 371 (74,2%). La distance médiane entre le lieu de violence et l’hôpital était de 11 km (IQR 7–15) ; cependant, 9 (1,8%) étaient venus dans l’heure après le traumatisme ; la transfusion était non faite ou insuffisante chez 169 (33,8%). Une issue défavorable (décès, référence, sortie contre-avis médical) était notée chez 57 (11,4%), avec 8,0% de décès. L’instabilité politique était la principale cause de violence. Une issue défavorable était associée à une transfusion insuffisante (rapport de risque [RR] 2,4 ; IC 95% 1,4–4,3 ; P = 0,006) ou à une blessure par balle (RR 2,4 ; IC 95% 1,1–5,2 ; P = 0,002).
CONCLUSION
Les TA par balle étaient fréquents durant la période des évènements socio-politiques 2020–2021. Le manque de produits sanguins a eu un impact négatif sur l’issue des patients. Les mesures de sécurité et la collecte de sang doivent toujours être maintenues et renforcées.
Journal Article > ResearchFull Text
Public Health Action. 2023 August 1; Volume 13 (Issue 2(Suppl 1)); 30-35.; DOI:10.5588/pha.23.0006
Tito MG, Makelele JPK, van den Boogaard W, Ade S, Deselets A, et al.
Public Health Action. 2023 August 1; Volume 13 (Issue 2(Suppl 1)); 30-35.; DOI:10.5588/pha.23.0006
CONTEXTE
Dans un pays d’Afrique émaillé de violences de guerre, Médecins Sans Frontières appui deux hôpitaux régionaux de références, pour répondre aux urgences incluant le traitement des traumatismes par arme-à-feu. Il facilite l’accès aux soins et références qui sont régulièrement entravés pour des raisons non médicales.
OBJECTIF
Déterminer les facteurs influençant l’issue défavorable des cas référés pour traumatisme par arme-à-feu (décembre 2020–novembre 2021).
TYPE D’ÉTUDE
Ceci est une étude transversale utilisant des données collectées de routine.
RÉSULTATS
Au total, 381 patients, victimes de traumatisme par arme-à-feu étaient admis avec une moyenne d’âge de 29 ans ; 28,3% étaient des lésions des gravités sévères dont les lésions thoraco-abdominale et les fractures. La mortalité était 4,9% et les sortis contre-avis médical 7,9%. Les patients d’affiliation force irrégulière représentaient 45,4%, et avaient deux sur trois fois une référence non-aboutie pour des raisons non-médicales. Les patients avec des lésions sévères au triage : l’affiliation, force irrégulière et armée régulière avaient respectivement 2 (P < 0,01), 5,9 (P < 0,01) et 8,1 (P < 0,01) fois plus de risque d’avoir une issue défavorable.
CONCLUSION
Les cas graves causés par des blessures par arme-à-feu risquaient d’avoir plus d’une issue défavorable. Ceci était amplifié pour ceux d’une certaine affiliation, qui se voyaient plus souvent refuser l’accès aux soins de référence supérieur plutôt basé sur des raisons sociopolitiques que sur des raisons médicales.
Dans un pays d’Afrique émaillé de violences de guerre, Médecins Sans Frontières appui deux hôpitaux régionaux de références, pour répondre aux urgences incluant le traitement des traumatismes par arme-à-feu. Il facilite l’accès aux soins et références qui sont régulièrement entravés pour des raisons non médicales.
OBJECTIF
Déterminer les facteurs influençant l’issue défavorable des cas référés pour traumatisme par arme-à-feu (décembre 2020–novembre 2021).
TYPE D’ÉTUDE
Ceci est une étude transversale utilisant des données collectées de routine.
RÉSULTATS
Au total, 381 patients, victimes de traumatisme par arme-à-feu étaient admis avec une moyenne d’âge de 29 ans ; 28,3% étaient des lésions des gravités sévères dont les lésions thoraco-abdominale et les fractures. La mortalité était 4,9% et les sortis contre-avis médical 7,9%. Les patients d’affiliation force irrégulière représentaient 45,4%, et avaient deux sur trois fois une référence non-aboutie pour des raisons non-médicales. Les patients avec des lésions sévères au triage : l’affiliation, force irrégulière et armée régulière avaient respectivement 2 (P < 0,01), 5,9 (P < 0,01) et 8,1 (P < 0,01) fois plus de risque d’avoir une issue défavorable.
CONCLUSION
Les cas graves causés par des blessures par arme-à-feu risquaient d’avoir plus d’une issue défavorable. Ceci était amplifié pour ceux d’une certaine affiliation, qui se voyaient plus souvent refuser l’accès aux soins de référence supérieur plutôt basé sur des raisons sociopolitiques que sur des raisons médicales.
Conference Material > Abstract
Hadiuzzaman M, Yantzi R, van den Boogaard W, Lim SY, Gupta PS, et al.
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/2hjs-zc19
INTRODUCTION
Maternal health indicators remain unacceptably poor within the densely populated Rohingya refugee camps in Cox’s Bazar, Bangladesh. With a high prevalence of home births, we sought to explore perceptions, experiences, and expectations around delivery care of women of reproductive age. We also examined the potential roles of family and key community members within Camp 22, a relatively isolated camp with 23,000 refugees where MSF is the only provider of facility-based maternity care.
METHODS
In 2021, we selected 45 participants from Camp 22 through purposive and snowball sampling for in-depth interviews. Participants included 36 Rohingya women and their family members, three traditional birth attendants (TBA’s) and six community and religious leaders. Interviews were recorded, translated and transcribed into English by trained staff fluent in Rohingya. Thematic-content analysis was performed, whereby codes and emerging themes were identified.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the ERB of Bangladesh University of Health Sciences.
RESULTS
Findings showed that delivery choices were made as a family, with husband and parents-in-law being primary decision makers. An uncomplicated birth was not perceived as requiring facility-based assistance; many women preferred to give birth at home assisted by TBA’s, family, or local healers, due to placing greater trust in their own community. Lack of security and transport were crucial determinants in repudiating facility-based care at night. Concerns about male staff and being undressed during facility-based births, as well as the possibility of onward referrals should surgery or episiotomies be required, drove hesitancy. Separation from family and children added more anxiety. Lack of understanding by facility staff towards Rohingya birthing practices and beliefs, and the Rohingya’s unfamiliarity with formally-trained midwives and medical procedures, featured heavily in decisions for home births. Factors such as utilising birthing ropes and guaranteed privacy at home were key influencers for choosing home births. Additionally, perceived inexperience of midwives and lack of autonomy while in the facility, were other common reasons for apprehension.
CONCLUSION
This study emphasizes community trust as a factor in collective decision-making regarding birth choices. Trust was higher in TBA’s than in formally-trained midwives and this negatively affected perceptions regarding competence. Perceptions may also be affected by rapid midwife turnover, a factor endemic to non-governmental organizations working in Cox’s Bazar. The persistent gap in cultural understanding and adaptation by facility-based staff, even after three years of presence, suggests the need for a more iterative, inclusive and reflective approach, with community engagement strategies founded on beneficiaries own explicitly stated needs, beliefs and practices.
CONFLICTS OF INTEREST
None declared
Maternal health indicators remain unacceptably poor within the densely populated Rohingya refugee camps in Cox’s Bazar, Bangladesh. With a high prevalence of home births, we sought to explore perceptions, experiences, and expectations around delivery care of women of reproductive age. We also examined the potential roles of family and key community members within Camp 22, a relatively isolated camp with 23,000 refugees where MSF is the only provider of facility-based maternity care.
METHODS
In 2021, we selected 45 participants from Camp 22 through purposive and snowball sampling for in-depth interviews. Participants included 36 Rohingya women and their family members, three traditional birth attendants (TBA’s) and six community and religious leaders. Interviews were recorded, translated and transcribed into English by trained staff fluent in Rohingya. Thematic-content analysis was performed, whereby codes and emerging themes were identified.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the ERB of Bangladesh University of Health Sciences.
RESULTS
Findings showed that delivery choices were made as a family, with husband and parents-in-law being primary decision makers. An uncomplicated birth was not perceived as requiring facility-based assistance; many women preferred to give birth at home assisted by TBA’s, family, or local healers, due to placing greater trust in their own community. Lack of security and transport were crucial determinants in repudiating facility-based care at night. Concerns about male staff and being undressed during facility-based births, as well as the possibility of onward referrals should surgery or episiotomies be required, drove hesitancy. Separation from family and children added more anxiety. Lack of understanding by facility staff towards Rohingya birthing practices and beliefs, and the Rohingya’s unfamiliarity with formally-trained midwives and medical procedures, featured heavily in decisions for home births. Factors such as utilising birthing ropes and guaranteed privacy at home were key influencers for choosing home births. Additionally, perceived inexperience of midwives and lack of autonomy while in the facility, were other common reasons for apprehension.
CONCLUSION
This study emphasizes community trust as a factor in collective decision-making regarding birth choices. Trust was higher in TBA’s than in formally-trained midwives and this negatively affected perceptions regarding competence. Perceptions may also be affected by rapid midwife turnover, a factor endemic to non-governmental organizations working in Cox’s Bazar. The persistent gap in cultural understanding and adaptation by facility-based staff, even after three years of presence, suggests the need for a more iterative, inclusive and reflective approach, with community engagement strategies founded on beneficiaries own explicitly stated needs, beliefs and practices.
CONFLICTS OF INTEREST
None declared
Conference Material > Slide Presentation
Hadiuzzaman M, Yantzi R, van den Boogaard W, Lim SY, Gupta PS, et al.
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/qwgn-be73
Journal Article > ResearchFull Text
Obstetric fistula in Burundi: a comprehensive approach to managing women with this neglected disease
BMC Pregnancy Childbirth. 2013 August 21; Volume 13 (Issue 1); 164.
Tayler-Smith K, Zachariah R, Manzi M, van den Boogaard W, Vandeborne A, et al.
BMC Pregnancy Childbirth. 2013 August 21; Volume 13 (Issue 1); 164.
BACKGROUND
In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000-2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
METHODS
Descriptive study using routine programme data.
RESULTS
Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31-51 days).
CONCLUSION
In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.
In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000-2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
METHODS
Descriptive study using routine programme data.
RESULTS
Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31-51 days).
CONCLUSION
In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.
Journal Article > ResearchFull Text
PLOS One. 2017 February 7; Volume 12 (Issue 2); e0170882.; DOI:10.1371/journal.pone.0170882
de Plecker E, Zachariah R, Kumar AMV, Trelles M, Caluwaerts C, et al.
PLOS One. 2017 February 7; Volume 12 (Issue 2); e0170882.; DOI:10.1371/journal.pone.0170882
OBJECTIVES
In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.
METHODS
A retrospective analysis of EmOC data (2011 and 2012).
RESULTS
A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).
A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.
CONCLUSION
Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.
METHODS
A retrospective analysis of EmOC data (2011 and 2012).
RESULTS
A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).
A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.
CONCLUSION
Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
Journal Article > ResearchFull Text
Int Health. 2016 November 3; Volume 8 (Issue 6); 390-397.; DOI:10.1093/inthealth/ihw035
Valles P, Van den Bergh R, van den Boogaard W, Tayler-Smith K, Gayraud O, et al.
Int Health. 2016 November 3; Volume 8 (Issue 6); 390-397.; DOI:10.1093/inthealth/ihw035
BACKGROUND
Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.
METHODS
A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014.
RESULTS
31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours.
CONCLUSIONS
This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.
Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.
METHODS
A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014.
RESULTS
31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours.
CONCLUSIONS
This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs.