BACKGROUND

Access to safe abortion care (SAC) should be improved in fragile and humanitarian settings, and the implementation of interventions in that regard are currently limited. This is especially true for self-managed abortion (SMA), although it holds the potential of revolutionizing the prevention of maternal death and suffering.

CASE PRESENTATION

The medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) piloted a self-managed abortion model of care in the Middle East. 22 women were remotely supported in managing their safe abortions with a counsellor over the phone, using misoprostol doses that they took at home after having taken mifepristone in our health facility. We share our experience by describing the model of care and discussing the lessons learned through its implementation.

CONCLUSIONS

The program delivered abortion services successfully and required few resources. This paper also reflects on the importance of facilitating SMA in humanitarian contexts. It increases access to care by providing increased confidentiality, close support, ample information, autonomy, and flexibility. It is simple to implement, effective, often preferred by women, and can be linked to information about contraception. The implementation of self-managed models should be expanded, notably in projects that do not have a sexual and reproductive health focus and in restrictive and challenging contexts. It represents a true revolution for access to safe abortion care.

BACKGROUND

Improving treatment success rates among multi drug-resistant tuberculosis (MDR-TB) patients is critical to reducing its incidence and mortality, but adherence poses an important challenge. Video-based direct observed therapy (vDOT) may provide adherence benefits, while addressing the time and cost burden associated with community treatment supporter (CTS)-DOT. This study explored experiences of patients, family members and healthcare workers with different DOT modalities for adherence support in Eswatini.

METHODS

Between April 2021 and May 2022, thirteen men and five women with MDR-TB, ten healthcare workers, and nine caregivers were purposively sampled to include a range of characteristics and experiences with DOT modalities. Data were generated through individual in-depth interviews and a smartphone messaging application (WhatsApp). Data coding was undertaken iteratively, and thematic analysis undertaken, supported by Nvivo.

RESULTS

Four themes emerged that reflected participants’ experiences with different DOT modalities, including stigma, efficiency, perceived risks of TB acquisition, and patient autonomy. vDOT was appreciated by patients for providing them with privacy and shielding them from stigmatisation associated with being seen in TB clinics or with community treatment supporters. vDOT was also seen as more efficient than CTS-DOT. Health workers acknowledged that it saved time, allowing them to attend to more patients, while many patients found vDOT more convenient and less expensive by removing the need to travel for in-person consultations. Health workers also appreciated vDOT because it reduced risks of TB acquisition by minimising exposure through virtual patient monitoring. Although many patients appreciated greater autonomy in managing their illness through vDOT, others preferred human contact or struggled with making video recordings. Most family members appreciated vDOT, although some resented feeling removed from the process of supporting loved ones.

CONCLUSIONS

vDOT was generally appreciated by MDR-TB patients, their family members and health workers as it addressed barriers to adherence which could contribute to improved treatment completion rates and reduced workplace exposure. However, patients should be offered an alternative to vDOT such as CTS-DOT if this modality does not suit their circumstances or preferences.

BACKGROUND AND OBJECTIVES Le Centre de Sante de Référence de Douentza fait face à des nombreux défis des soins néonataux exacerbés par le contexte d’accès très limités. Plusieurs initiatives ont été envisagées notamment le support continu du Pédiatre, analyses des causes des décès et définition des plans d’action, formation au lit des malades. Pour accéder et accompagner le personnel soignant, une formation virtuelle intersectionnelle des soins néonataux a été réalisée pendant 2,5 mois pour une équipe de 7 staffs (infirmières et médecins). Le partage de cette expérience a comme objectif de montrer les bonnes pratiques possibles dans ces contextes. CASE DESCRIPTION Après cette formation virtuelle interactive, l’équipe a pris l’initiative d’identifier les grands défis à relever pour améliorer les soins néonataux à travers une évaluation approfondie (arbre à problèmes) des pratiques de soins dans le projet. La collecte d’informations comprenait des observations sur place à travers des entretiens avec le personnel de santé et avec des accompagnants, des dossiers des patients ainsi que les audits de décès. Définition et implémentation du plan d’amélioration qui a permis : • Réorganisation de la salle de néonatologie en fonction du degré d’urgence : rouge, orange, vert, zone de réanimation. • Meilleure acceptance en interne et sensibilisation sur les soins de la mère kangourou et zéro séparation. • Mise en place et maitrise du protocole de prise en charge (PEC) et de la réanimation néonatale. • Consensus et adoption des critères de PEC (admissions, référence, soins palliatifs). • Travail en amont avec l’équipe de la Promotion de santé et engagement communautaire pour le recours précoce aux soins.

CONCLUSIONS La formation virtuelle a permis non seulement d’interagir, d’acquérir des nouvelles connaissances mais aussi l ́analyse et détection des causes profondes du problème, proposer des interventions ciblées à court et moyen terme ; définir le chronogramme d’implémentation ainsi que les indicateurs de suivi. Des changements perceptibles sont opérés et continueront pour des soins néonataux appropriés.