Conference Material > Video (talk)
Ajamah S
MSF Paediatric Days 2022. 2022 December 1; DOI:10.57740/95q8-ne84
Journal Article > ResearchFull Text
Hum Resour Health. 2015 July 21; Volume 13 (Issue 1); DOI:10.1186/s12960-015-0053-z
O Hare B, Phiri A, Lang HJ, Friesen H, Kennedy N, et al.
Hum Resour Health. 2015 July 21; Volume 13 (Issue 1); DOI:10.1186/s12960-015-0053-z
Eighty per cent of Malawi's 8 million children live in rural areas, and there is an extensive tiered health system infrastructure from village health clinics to district hospitals which refers patients to one of the four central hospitals. The clinics and district hospitals are staffed by nurses, non-physician clinicians and recently qualified doctors. There are 16 paediatric specialists working in two of the four central hospitals which serve the urban population as well as accepting referrals from district hospitals. In order to provide expert paediatric care as close to home as possible, we describe our plan to task share within a managed clinical network and our hypothesis that this will improve paediatric care and child health.
Conference Material > Video (talk)
Komano MS
MSF Scientific Days International 2022. 2022 June 7; DOI:10.57740/j5wc-g670
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.
Conference Material > Abstract
Robinson E, van Braak F, Rose L, Yadenzi MS
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
Protracted conflict in CAR has led to widespread political unrest and fragile health systems. Hyperendemic malaria is the main cause of morbidity. Alongside global calls to prioritise malaria prevention during the COVID-19 pandemic, MSF initiated mass drug administration (MDA) for children aged between three months and 15 years within three communes of the Bossangoa health district between 17 August and 24 November 2020. The MDA comprised three cycles of dihydroartemisin-piperaquine (DHA-PQ), given at four-week intervals. We evaluated coverage and clinical impact of the MDA, and describe community perspectives.
METHODS
We conducted a two-stage cluster household survey between 22 November and 9 December 2020. We undertook structured interviews with the heads of households and with eligible children, focusing on participation in the MDA. Participation was verified against the MDA card, if available. Using routine MSF surveillance data, we compared the following indicators during the MDA intervention to the same periods of time during 2018 and 2019: consultations, confirmed malaria cases, and positivity rates of malaria rapid diagnostic tests (mRDT’s) in MSF facilities in the intervention area, overall and by age group (≥5; <5 years); hospital admissions and in-hospital deaths with a primary diagnosis of severe malaria among children <15 years from the MDA intervention area. Following each cycle we conducted nine focus groups discussions (FGD’s) with caregivers, community leaders, and community health workers (CHW’s) Participants were selected using purposive sampling. The topic guide inluded the key themes of reasons for participation, difficulties encountered, satisfaction, and experiences throughout the MDA.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the national ERB of CAR.
RESULTS
In total, we distributed 134,117 DHA-PQ courses. Among eligible children, 93.1% (95% confidence interval, CI, 85.6-96.8) received all three cycles. We estimated significant reductions only for confirmed outpatient malaria cases overall (9.2%; 95% CI 5.6-12.8), and among those aged <5 years (20.5%; 95% CI 15.3-25.8). Following the first MDA cycle, FGD participants described positive perceptions and high adherence with regard to MDA, linked with the involvement of community leaders. Participants reported reductions in childhood malaria, as well as reduced household expenditure on healthcare. Rumours about ‘drug trials’ and concerns about side effects were initial reasons for refusal, however these concerns were overcome after seeing the positive impact on participating children. Participants’ recommendations included continuing the programme and expanding eligibility.
CONCLUSION
This is one of the first such MDA’s in CAR; our experience demonstrates MDA is feasible in complex emergencies. Although preliminary analysis of routine surveillance data suggested a limited impact on malaria diagnoses, community acceptance was high. Of note, outpatient surveillance data was limited to three structures in only one commune, and not available for the specific target ages of the MDA. Participants noted positive perceptions of impact, with a desire for repeated MDA’s. Further analysis will help to further elucidate the potential impact, and inform recommendations.
Protracted conflict in CAR has led to widespread political unrest and fragile health systems. Hyperendemic malaria is the main cause of morbidity. Alongside global calls to prioritise malaria prevention during the COVID-19 pandemic, MSF initiated mass drug administration (MDA) for children aged between three months and 15 years within three communes of the Bossangoa health district between 17 August and 24 November 2020. The MDA comprised three cycles of dihydroartemisin-piperaquine (DHA-PQ), given at four-week intervals. We evaluated coverage and clinical impact of the MDA, and describe community perspectives.
METHODS
We conducted a two-stage cluster household survey between 22 November and 9 December 2020. We undertook structured interviews with the heads of households and with eligible children, focusing on participation in the MDA. Participation was verified against the MDA card, if available. Using routine MSF surveillance data, we compared the following indicators during the MDA intervention to the same periods of time during 2018 and 2019: consultations, confirmed malaria cases, and positivity rates of malaria rapid diagnostic tests (mRDT’s) in MSF facilities in the intervention area, overall and by age group (≥5; <5 years); hospital admissions and in-hospital deaths with a primary diagnosis of severe malaria among children <15 years from the MDA intervention area. Following each cycle we conducted nine focus groups discussions (FGD’s) with caregivers, community leaders, and community health workers (CHW’s) Participants were selected using purposive sampling. The topic guide inluded the key themes of reasons for participation, difficulties encountered, satisfaction, and experiences throughout the MDA.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the national ERB of CAR.
RESULTS
In total, we distributed 134,117 DHA-PQ courses. Among eligible children, 93.1% (95% confidence interval, CI, 85.6-96.8) received all three cycles. We estimated significant reductions only for confirmed outpatient malaria cases overall (9.2%; 95% CI 5.6-12.8), and among those aged <5 years (20.5%; 95% CI 15.3-25.8). Following the first MDA cycle, FGD participants described positive perceptions and high adherence with regard to MDA, linked with the involvement of community leaders. Participants reported reductions in childhood malaria, as well as reduced household expenditure on healthcare. Rumours about ‘drug trials’ and concerns about side effects were initial reasons for refusal, however these concerns were overcome after seeing the positive impact on participating children. Participants’ recommendations included continuing the programme and expanding eligibility.
CONCLUSION
This is one of the first such MDA’s in CAR; our experience demonstrates MDA is feasible in complex emergencies. Although preliminary analysis of routine surveillance data suggested a limited impact on malaria diagnoses, community acceptance was high. Of note, outpatient surveillance data was limited to three structures in only one commune, and not available for the specific target ages of the MDA. Participants noted positive perceptions of impact, with a desire for repeated MDA’s. Further analysis will help to further elucidate the potential impact, and inform recommendations.
Journal Article > ResearchFull Text
AIDS Res Treat. 2013 July 17; Volume 2013 (Issue 937456); 1-8.; DOI: 10.1155/2013/937456
Geelhoed D, Decroo T, Dezembro S, Matias H, Lessitala F, et al.
AIDS Res Treat. 2013 July 17; Volume 2013 (Issue 937456); 1-8.; DOI: 10.1155/2013/937456
Mozambique continues to face many challenges in HIV and maternal and child health care (MCH). Community-based antiretroviral treatment groups (CAG) enhance retention to care among members, but whether such benefits extend to their families and to MCH remains unclear. In 2011 we studied utilization of HIV and MCH services among CAG members and their family aggregates in Changara, Mozambique, through a mixed-method assessment. We systematically revised all patient-held health cards from CAG members and their non-CAG family aggregate members and conducted semistructured group discussions on MCH topics. Quantitative data were analysed in EPI-Info. Qualitative data were manually thematically analysed. Information was retrieved from 1,624 persons, of which 420 were CAG members (26%). Good compliance with HIV treatment among CAG members was shared with non-CAG HIV-positive family members on treatment, but many family aggregate members remained without testing, and, when HIV positive, without HIV treatment. No positive effects from the CAG model were found for MCH service utilization. Barriers for utilization mentioned centred on insufficient knowledge, limited community-health facility collaboration, and structural health system limitations. CAG members were open to include MCH in their groups, offering the possibility to extend patient involvement to other health needs. We recommend that lessons learnt from HIV-based activism, patient involvement, and community participation are applied to broader SRH services, including MCH care.
Journal Article > ReviewFull Text
PLOS One. 2015 September 2; Volume 10 (Issue 9); e0135270.; DOI:10.1371/journal.pone.0135270
Bonner K, Welch E, Elder K, Cohn J
PLOS One. 2015 September 2; Volume 10 (Issue 9); e0135270.; DOI:10.1371/journal.pone.0135270
INTRODUCTION
Pneumococcal conjugate vaccine (PCV) is included in the World Health Organization's routine immunization schedule and is recommended by WHO for vaccination in high-risk children up to 60 months. However, many countries do not recommend vaccination in older age groups, nor have donors committed to supporting extended age group vaccination. To better inform decision-making, this systematic review examines the direct impact of extended age group vaccination in children over 12 months in low and middle income countries.
METHODS
An a priori protocol was used. Using pre-specified terms, a search was conducted using PubMed, LILACS, Cochrane Infectious Diseases Group Specialized Register, Cochrane Central Register of Controlled Trials, CAB Abstracts, clinicaltrials.gov and the International Symposium on Pneumococci and Pneumococcal Diseases abstracts. The primary outcome was disease incidence, with antibody titers and nasopharyngeal carriage included as secondary outcomes.
RESULTS
Eighteen studies reported on disease incidence, immune response, and nasopharyngeal carriage. PCV administered after 12 months of age led to significant declines in invasive pneumococcal disease. Immune response to vaccine type serotypes was significantly higher for those vaccinated at older ages than the unimmunized at the established 0.2 ug/ml and 0.35 ug/ml thresholds. Vaccination administered after one year of age significantly reduced VT carriage with odds ratios ranging from 0.213 to 0.69 over four years. A GRADE analysis indicated that the studies were of high quality.
DISCUSSION
PCV administration in children over 12 months leads to significant protection. The direct impact of PCV administration, coupled with the large cohort of children missed in first year vaccination, indicates that countries should initiate or expand PCV immunization for extended age group vaccinations. Donors should support implementation of PCV as part of delayed or interrupted immunization for older children. For countries to effectively implement extended age vaccinations, access to affordably-priced PCV is critical.
Pneumococcal conjugate vaccine (PCV) is included in the World Health Organization's routine immunization schedule and is recommended by WHO for vaccination in high-risk children up to 60 months. However, many countries do not recommend vaccination in older age groups, nor have donors committed to supporting extended age group vaccination. To better inform decision-making, this systematic review examines the direct impact of extended age group vaccination in children over 12 months in low and middle income countries.
METHODS
An a priori protocol was used. Using pre-specified terms, a search was conducted using PubMed, LILACS, Cochrane Infectious Diseases Group Specialized Register, Cochrane Central Register of Controlled Trials, CAB Abstracts, clinicaltrials.gov and the International Symposium on Pneumococci and Pneumococcal Diseases abstracts. The primary outcome was disease incidence, with antibody titers and nasopharyngeal carriage included as secondary outcomes.
RESULTS
Eighteen studies reported on disease incidence, immune response, and nasopharyngeal carriage. PCV administered after 12 months of age led to significant declines in invasive pneumococcal disease. Immune response to vaccine type serotypes was significantly higher for those vaccinated at older ages than the unimmunized at the established 0.2 ug/ml and 0.35 ug/ml thresholds. Vaccination administered after one year of age significantly reduced VT carriage with odds ratios ranging from 0.213 to 0.69 over four years. A GRADE analysis indicated that the studies were of high quality.
DISCUSSION
PCV administration in children over 12 months leads to significant protection. The direct impact of PCV administration, coupled with the large cohort of children missed in first year vaccination, indicates that countries should initiate or expand PCV immunization for extended age group vaccinations. Donors should support implementation of PCV as part of delayed or interrupted immunization for older children. For countries to effectively implement extended age vaccinations, access to affordably-priced PCV is critical.
Conference Material > Poster
Kenntner S, Samba Yadensi M, Fiddler J, Baieli E, Leone G, et al.
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/j7vc-x981
Journal Article > ResearchAbstract Only
J Viral Hepat. 2020 May 2; Volume 27 (Issue 9); 886-895.; DOI:10.1111/jvh.13311
Zhang M, O'Keefe D, Iwamoto M, Sann K, Kien A, et al.
J Viral Hepat. 2020 May 2; Volume 27 (Issue 9); 886-895.; DOI:10.1111/jvh.13311
Safe and efficacious pan-genotypic direct-acting antiviral (DAA) regimens, such as sofosbuvir and daclatasvir (SOF+DCV) facilitate simplified models of care for hepatitis C virus (HCV). However, in Cambodia access to HCV testing and treatment has typically been low. In response, Médecins Sans Frontières(MSF) implemented a HCV testing and treatment pilot project in Phnom Penh, Cambodia in 2016. This project provides the first real-world evidence of SOF+DCV effectiveness across a large patient cohort using a simplified care model in Cambodia. Patients treated with SOF+DCV from September 2016 to June 2019 were included in the analysis. Medical standard operational procedures (SOPs) were simplified significantly across the study period. Treatment effectiveness was assessed by sustained viral response at 12 weeks post-treatment (SVR12) according to a modified intention to treat methodology. Treatment safety was assessed by clinical outcome and occurrence of serious and non-serious adverse events (S/AE). Of 9158 patients, median age was 57 years and 39.6% were male. At baseline assessment, 27.2% of patients had compensated cirrhosis and 2.9% had decompensated cirrhosis. Genotype 6 was predominant (53.0%). Among patients analysed according to modified intention to treat (n=8525), treatment effectiveness was high, with 97.2% of patients achieving SVR12. Occurrence of SAE was low (0.7%). Treatment effectiveness and safety was not affected by the iterative simplification to treatment modality. In conclusion, in this large treatment cohort in Phnom Penh, Cambodia, the SOF+DCV regimen showed high rates of treatment effectiveness and safety across patient sub-groups and during progressive simplification.
Conference Material > Slide Presentation
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 May 10; DOI:10.57740/74t1-zq11