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1
Buckels, John. "Global surgery and Médecins Sans Frontières." Bulletin of the Royal College of Surgeons of England 98, no. 8 (September 2016): 345–47. http://dx.doi.org/10.1308/rcsbull.2016.345.
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Binet, Laurence. "Médecins Sans Frontières en Tchétchénie de 1994 à 2004." Connexe : les espaces postcommunistes en question(s) 1 (July 12, 2015): 119–37. http://dx.doi.org/10.5077/journals/connexe.2015.e36.
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Cet article a été rédigé à partir de l’étude Crimes de guerre et politiques de terreur en Tchétchénie 1994-2004, réalisée par Laurence Binet et publiée dans la collection « Prises de parole publiques de Médecins Sans Frontières ». Cette collection de MSF, à destination interne, est progressivement rendue publique sur le site http://www.speakingout.msf.org. Elle s’efforce de décrire les processus de prise de décision qui ont mené aux positionnements publics de MSF lors de grandes crises humanitaires, ainsi que les dilemmes et controverses qui les ont accompagnés. Les études y prennent la forme d’un récit chronologique composé d’extraits de documents propres à l’organisation (rapports de situation, de mission, échanges de courriels, comptes rendus de réunions, communiqués de presse, rapports de témoignages) et d’articles de presse. S’y ajoutent des extraits d’entretiens menés avec les protagonistes de MSF, acteurs des processus. À partir de ces sources, l’article proposé ici décrit les positionnements publics de Médecins Sans Frontières, lors de la première (1994-1996) puis de la seconde guerre de Tchétchénie (après 1999) et rappelle le contexte opérationnel dans lequel ils s’inscrivaient. L’article se propose ensuite d’examiner les principaux questionnements et dilemmes que ces prises de paroles publiques ont posés à l’organisation aussi bien au moment où il fallait décider d’un positionnement public qu’a posteriori.
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CHATWANI, NEHA, and GAZI ISLAM. "Humanitarian identifications: heterogeneous responses to institutional complexity at Médecins Sans Frontières." Cadernos EBAPE.BR 18, spe (November 2020): 648–66. http://dx.doi.org/10.1590/1679-395120200188x.
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Abstract Studies of institutional complexity have explored how multiple logics influence organizational practices. This article illustrates how a single logic is maintained through its heterogeneous enactments and practices, via strong identification, in this case, with the logic of humanitarianism. Using the case of Médecins Sans Frontières (MSF), we develop a theory around identity work and the heterogeneous enactment of institutional logic. We illustrate, via three historical examples, how MSF engaged in radically different practices across time and space, while adhering to a continuous yet polymorphous humanitarian logic. We explain this apparent paradox by referring to the internal contradictions within humanitarian logics, contradictions that do not lead to chaos because of the persistent cohesion effects of identity. We discuss implications for understanding organizational identity and institutional diversity.
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Abu Sa'Da, Caroline, and Xavier Crombé. "Volunteers and responsibility for risk-taking: Changing interpretations of the Charter of Médecins Sans Frontières." International Review of the Red Cross 97, no. 897-898 (June 2015): 133–55. http://dx.doi.org/10.1017/s1816383115000740.
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AbstractThe Charter of Médecins Sans Frontières (MSF), the guiding document for all of the organization's members, states in the final paragraph that volunteers “understand the risks and dangers of the missions they carry out”. Through a review of the different periods in the history of MSF, this article analyzes the changing interpretations that the organization's successive leaders have given to this reference to the acceptance of risk by individuals. The professionalization and expansion of MSF, coupled with its diversifying volunteer base and the changing international environment, have required constant renegotiation of the balance between institutional and individual responsibility for the dangers faced in the field. No doubt this process is far from over.
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Duroch, Françoise, and Catrin Schulte-Hillen. "Care for victims of sexual violence, an organization pushed to its limits: The case of Médecins Sans Frontières." International Review of the Red Cross 96, no. 894 (June 2014): 601–24. http://dx.doi.org/10.1017/s1816383115000107.
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AbstractOver the past ten years, Médecins Sans Frontières (MSF) has provided medical care to almost 118,000 victims of sexual violence. Integrating related care into MSF general assistance to populations affected by crisis and conflicts has presented a considerable institutional struggle and continues to be a challenge. Tensions regarding the role of MSF in providing care to victims of sexual violence and when facing the multiple challenges inherent in dealing with this crime persist. An overview of MSF's experience and related reflection aims to share with the reader, on the one hand, the complexity of the issue, and on the other, the need to continue fighting for the provision of adequate medical care for victims of sexual violence, which despite the limitations is feasible.
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Wilhelm-Solomon, Matthew, and Jens Pedersen. "Crossing the Borders of Humanitarianism: Médecins Sans Frontières (MSF) in Inner-City Johannesburg." Urban Forum 28, no. 1 (June 23, 2016): 5–26. http://dx.doi.org/10.1007/s12132-016-9285-9.
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Calain, Philippe. "The interaction between humanitarian non-governmental organisations and extractive industries: a perspective from Médecins Sans Frontières." International Review of the Red Cross 94, no. 887 (September 2012): 1115–24. http://dx.doi.org/10.1017/s1816383113000374.
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AbstractThis opinion note explores some aspects of the relationship between humanitarian non-governmental organisations (NGOs) and extractive industries. Médecins sans Frontières (Doctors without Borders, MSF) has endorsed a policy of non-engagement with the corporate sector of the extractive industries, particularly when it comes to financial donations. This is coherent with MSF being first and foremost a medical organisation, and one that adheres to the humanitarian principles of independence and neutrality. For humanitarian actors, the prospect of future environmental disasters and environmental conflicts calls for the anticipation of novel encounters, not only with environmental organisations but also with the extractive sector. Unlike environmental organisations, extractive industries are prone to generating or perpetuating different forms of violence, often putting extractive companies on a par with the parties to armed conflicts. In situations where a dialogue with extractive companies would be needed to optimise care and access to victims, humanitarian organisations should carefully weigh pragmatic considerations against the risk of being co-opted as medical providers of mitigation measures.
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Rubio-Pinilla, Paula, and José Candón-Mena. "La comunicación digital de Médicos Sin Fronteras en España durante la crisis de la COVID-19." INDEX COMUNICACION 11, no. 2 (July 15, 2021): 231–55. http://dx.doi.org/10.33732/ixc/11/02lacomu.
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This article analyzes the digital communication of Médecins Sans Frontières (MSF) during its intervention in Spain due to the emergency caused by COVID-19. Using content analysis techniques, the text engages with a number of the messages posted on the MSF website, emails sent to partners and publications on Facebook and Twitter. The material (a total 58 messages) is categorized by subject, sender, format, and objective, as well as the presence of informative or emotional approaches. Complementarily, items such as intensity, positive or negative undertones and the terms most frequently used are also examined. Our conclusion points towards the use of digital communication with a view to reinforce MSF's public image as an entity specialized in health care in emergency situations. The unprecedented intervention in Spain during the COVID-19 crisis has also shown MSF to be accountable to its audiences, showing how the organization usually works in other countries.
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James, Myfanwy. "‘Who Can Sing the Song of MSF?’." Journal of Humanitarian Affairs 2, no. 2 (September 1, 2020): 31–39. http://dx.doi.org/10.7227/jha.041.
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This article explores the everyday practice of security management and negotiations for access conducted by Médecins Sans Frontières (MSF) in North Kivu, in the Democratic Republic of the Congo (DRC). Based on ethnographic fieldwork, interviews and archival exploration, it examines the experience of MSF Congolese employees, who navigate a complex politics of humanitarian fixing and brokerage. Their role in MSF is simultaneously defined and circumscribed by their political and social situation. MSF’s security management relies on local staff’s interpersonal networks and on their ability to interpret and translate. However, local staff find themselves at risk, or perceived as a ‘risk’: exposed to external pressures and acts of violence, while possibilities for promotion are limited precisely because of their embeddedness. They face a tension between being politically and socially embedded and needing to perform MSF’s principles in practice. As such, they embody the contradictions of MSF’s approach in North Kivu: a simultaneous need for operational ‘proximity’, as well as performative distance from everyday conflict processes.
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Bouchet-Saulnier, Françoise, and Jonathan Whittall. "An environment conducive to mistakes? Lessons learnt from the attack on the Médecins Sans Frontières hospital in Kunduz, Afghanistan." International Review of the Red Cross 100, no. 907-909 (April 2018): 337–72. http://dx.doi.org/10.1017/s1816383118000619.
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AbstractOn 3 October 2015, the Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan was bombed during a US–Afghan joint military operation to retake the city. Even before that night, attacks on health-care facilities in war zones were already a worrying trend and a major concern for humanitarian organizations. Such attacks have led both MSF and the International Committee of the Red Cross (ICRC) to launch campaigns1 addressing the need for greater protection of the medical mission in situations of armed conflict. Nonetheless, the scale and specific context of the attack on the Kunduz Trauma Centre have given rise to various specific investigations2 and provoked many more questions that this article will explore. The article will delve into the “many mistakes” scenario that has been presented by the US investigation in order to critically analyze whether these mistakes may originate from either incorrect or biased interpretations or implementation of international humanitarian law.
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Crombé, Xavier, and Joanna Kuper. "War Breaks Out." Journal of Humanitarian Affairs 1, no. 2 (May 1, 2019): 4–12. http://dx.doi.org/10.7227/jha.012.
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Abstract This article seeks to document and analyse violence affecting the provision of healthcare by Médecins Sans Frontières (MSF) and its intended beneficiaries in the early stage of the current civil war in South Sudan. Most NGO accounts and quantitative studies of violent attacks on healthcare tend to limit interpretation of their prime motives to the violation of international norms and deprivation of access to health services. Instead, we provide a detailed narrative, which contextualises violent incidents affecting healthcare, with regard for the dynamics of conflict in South Sudan as well as MSF’s operational decisions, and which combines and contrasts institutional and academic sources with direct testimonies from local MSF personnel and other residents. This approach offers greater insight not only into the circumstances and logics of violence but also into the concrete ways in which healthcare practices adapt in the face of attacks and how these may reveal and put to the test the reciprocal expectations binding international and local health practitioners in crisis situations.
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Gumbs, Andrew A., Dominique Anciaux, Ulrick Dezard, Laelle Mangurat, Rolph Richme, William H. Olibrice, Berldine Jean, Emilie Allaire, and Jean-Pierre LeToquart. "MSF Hospital in Tabarre, Haiti: Why a Field General Surgery Fellowship Is Necessary." Surgeries 2, no. 2 (April 15, 2021): 157–66. http://dx.doi.org/10.3390/surgeries2020016.
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Recently, the Hospital at Tabarre in Port-au-Prince Haiti was reopened by the Operational Center of Paris—Médecins Sans Frontières (MSF). This hospital is now purely a Trauma Center staffed by five national general surgeons and five orthopedic surgeons. MSF hopes that the new trauma focus of Tabarre Hospital and the presence of a full complement of experienced national surgeons can enable this site to become one of the training sites for exptriate surgeons on their first humanitarian mission with MSF. The general surgical case charts from the first 3 months after the reopening of the hospital were retrospectively reviewed. All procedures done by the general surgical department in the operating room theatre were registered and short and long-term results analyzed. The Hospital at Tabarre has a very high rate of penetrating traumas compared to other MSF hospitals, and seems ideally suited to train expatriate surgeons during their first missions in the field with MSF because of the experience of the National surgical staff. Additionally, it is felt that a longer Field General Surgery fellowship can and should be developed within MSF to ensure that the next generation of general surgeons can continue to provide the type of surgical care that is still needed in the field.
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Tanguy, Joelle, and Fiona Terry. "Humanitarian Responsibility and Committed Action." Ethics & International Affairs 13 (March 1999): 29–34. http://dx.doi.org/10.1111/j.1747-7093.1999.tb00324.x.
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Far from rejecting the classicist approach, as Thomas Weiss claims, Médecins Sans Frontières (MSF) follows the fundamental principle of providing aid in proportion to need and without discrimination. Actions that on Weiss's political continuum would be termed solidarist are less an expression of political preference than a determination to claim and operate within humanitarian space as well as to maintain accountability to international civil society through testimony (témoignage) regarding mass violations of human rights. Although providing aid in conflict is implicitly political, involving humanitarian actors and aid in conflict resolution initiatives, as Weiss advocates, risks diluting the primary responsibility of humanitarian aid to alleviate suffering. It also further shifts the responsibility for conflict resolution and the respect of international legal conventions from accountable political institutions to the private sphere. Is this where we want to lead humanitarianism?
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Janet, Sophie, Neal Russell, Nikola Morton, Daniel Martinez, Mona Tamannai, Nadia Lafferty, Harriet Roggeveen, et al. "MSF Paediatric Days: a step forward in operationalising ‘Humanitarian Paediatrics’." BMJ Paediatrics Open 5, no. 1 (September 2021): e001156. http://dx.doi.org/10.1136/bmjpo-2021-001156.
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Around the world, one in four children live in a country affected by conflict, political insecurity and disaster. Healthcare in humanitarian and fragile settings is challenging and complex to provide, particularly for children. Furthermore, there is a distinct lack of medical literature from humanitarian settings to guide best practice in such specific and resource-limited contexts. In light of these challenges, Médecins Sans Frontières (MSF), an international medical humanitarian organisation, created the MSF Paediatric Days with the aim of uniting field staff, policymakers and academia to exchange ideas, align efforts, inspire and share frontline research and experiences to advance humanitarian paediatric and neonatal care. This 2-day event takes place regularly since 2016. The fourth edition of the MSF Paediatric Days in April 2021 covered five main topics: essential newborn care, community-based models of care, paediatric tuberculosis, antimicrobial resistance in neonatal and paediatric care and the collateral damage of COVID-19 on child health. In addition, eight virtual stands from internal MSF initiatives and external MSF collaborating partners were available, and 49 poster communications and five inspiring short talks referred to as ‘PAEDTalks’ were presented. In conclusion, the MSF Paediatric Days serves as a unique forum to advance knowledge on humanitarian paediatrics and creates opportunities for individual and collective learning, as well as networking spaces for interaction and exchange of ideas.
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Benedetti, G., R. A. White, H. Akello Pasquale, J. Stassijns, W. van den Boogaard, P. Owiti, and R. Van den Bergh. "Identifying exceptional malaria occurrences in the absence of historical data in South Sudan: a method validation." Public Health Action 9, no. 3 (September 1, 2019): 90–95. http://dx.doi.org/10.5588/pha.19.0002.
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Background: Detecting unusual malaria events that may require an operational intervention is challenging, especially in endemic contexts with continuous transmission such as South Sudan. Médecins Sans Frontières (MSF) utilises the classic average plus standard deviation (AV+SD) method for malaria surveillance. This and other available approaches, however, rely on antecedent data, which are often missing.Objective: To investigate whether a method using linear regression (LR) over only 8 weeks of retrospective data could be an alternative to AV+SD.Design: In the absence of complete historical malaria data from South Sudan, data from weekly influenza reports from 19 Norwegian counties (2006–2015) were used as a testing data set to compare the performance of the LR and the AV+SD methods. The moving epidemic method was used as the gold standard. Subsequently, the LR method was applied in a case study on malaria occurrence in MSF facilities in South Sudan (2010–2016) to identify malaria events that required a MSF response.Results: For the Norwegian influenza data, LR and AV+SD methods did not perform differently (P > 0.05). For the South Sudanese malaria data, the LR method identified historical periods when an operational response was mounted.Conclusion: The LR method seems a plausible alternative to the AV+SD method in situations where retrospective data are missing.
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Khaldi, Hakim. "Humanitarian Field Practices in the Context of the Syrian Conflict from 2011 to 2018." Journal of Humanitarian Affairs 2, no. 2 (September 1, 2020): 48–57. http://dx.doi.org/10.7227/jha.043.
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How can we go about our work of saving lives when, in Syria, civilians, the wounded and their families, medical personnel and aid workers are all targets – whether in areas controlled by the government or those held by the Kurdish Democratic Union Party (PYD), Islamic State of Iraq and the Levant (ISIL) or various rebel groups with diverging political agendas? Over the course of several field missions, the author of this article, a member of Médecins Sans Frontières (MSF), sought to decipher the political and military engagements undertaken in different regions of Syria during the war years. He also factored into his analysis the endless flow of data, information and positioning being produced and published over this period, because the war was also fought every day on the internet where the representatives and ideologists of warring groups, human rights organisations, Syrian diaspora organisations and spokespersons of the Syrian central authorities were and still are a permanent presence. Drawing on all these observations and data, the author relates and analyses the emergency relief activities carried out by MSF in Syria, how these activities evolved and the conditions in which choices to intervene and decisions to withdraw were taken.
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Naidoo, Megan, James Lee, Miguel Trelles, Lee Wallis, and Kathryn M. Chu. "Preventing avoidable hospital admissions after emergency care in humanitarian settings: a cross-sectional review of Médecins Sans Frontières emergency departments." BMJ Open 11, no. 7 (July 2021): e049785. http://dx.doi.org/10.1136/bmjopen-2021-049785.
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ObjectivesThe aim of this study was to describe the types of emergency departments (EDs), and the acuity, types and disposition of conditions managed at Médecins Sans Frontières (MSF)-supported EDs in humanitarian settings.Design, setting, participants and outcome measuresThis was a multicentre, cross-sectional review of visits to MSF-supported EDs from 1 January 2014 to 31 December 2018. EDs were classified into advanced-level, general-level, paediatric and trauma. Variables analysed included: age group, condition, acuity and ED disposition. Frequencies and percentages stratified by ED type or region were reported.ResultsMSF supported 26 EDs in 12 countries, with a total of 1 388 698 visits between 2014 and 2018. Most patients were discharged home (n=1 097 456, 79%), with nearly 0% mortality (n=4692). The majority of visits at general-level and paediatric EDs were for medical conditions (n=600 088, 78% and n=45 276, 96%, respectively), while nearly half of advanced-level EDs visits were for surgical conditions (n=201 189, 48%). Almost all visits to trauma EDs were for surgical conditions (n=148 078, 98%). Overall, most surgical conditions were traumatic injuries (n=484 008, 94%), the majority unintentional (n=425 487, 82%). The top three most common classified medical conditions were respiratory infections, malaria and diarrhoea.ConclusionsEDs are critical in improving the agility and access to emergency care (EC) in humanitarian settings. This study demonstrated that EC provision resulted in the majority of patients being discharged from EDs, helping prevent avoidable hospital admissions. These results could help better understand the healthcare needs of vulnerable populations, improve responsiveness to emergency conditions and support programmatic planning in humanitarian settings.
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Gil Cuesta, J., M. Trelles, A. Naseer, A. Momin, L. Ngabo Mulamira, S. Caluwaerts, and D. Guha-Sapir. "Does the presence of conflict affect maternal and neonatal mortality during Caesarean sections?" Public Health Action 9, no. 3 (September 1, 2019): 107–12. http://dx.doi.org/10.5588/pha.18.0045.
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Introduction: Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.Objective: To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.Methods: We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.Results: During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).Conclusions: Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
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Kudsk-Iversen, Søren, Miguel Trelles, Elie Ngowa Bakebaanitsa, Longin Hagabimana, Abdul Momen, Rahmatullah Helmand, Carline Saint Victor, et al. "Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years." BMJ Open 10, no. 3 (March 2020): e034891. http://dx.doi.org/10.1136/bmjopen-2019-034891.
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ObjectiveTo describe the extent to which different categories of anaesthesia provider are used in humanitarian surgical projects and to explore the volume and nature of their surgical workload.DesignDescriptive analysis using 10 years (2008–2017) of routine case-level data linked with routine programme-level data from surgical projects run exclusively by Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB).SettingProjects were in contexts of natural disaster (ND, entire expatriate team deployed by MSF-OCB), active conflict (AC) and stable healthcare gaps (HG). In AC and HG settings, MSF-OCB support pre-existing local facilities. Hospital facilities ranged from basic health centres with surgical capabilities to tertiary referral centres.ParticipantsThe full dataset included 178 814 surgical cases. These were categorised by most senior anaesthetic provider for the project, according to qualification: specialist physician anaesthesiologists, qualified nurse anaesthetists and uncertified anaesthesia providers.Primary outcome measureVolume and nature of surgical workload of different anaesthesia providers.ResultsFull routine data were available for 173 084 cases (96.8%): 2518 in ND, 42 225 in AC, 126 936 in HG. Anaesthesia was predominantly led by physician anaesthesiologists (100% in ND, 66% in AC and HG), then nurse anaesthetists (19% in AC and HG) or uncertified anaesthesia providers (15% in AC and HG). Across all settings and provider groups, patients were mostly healthy young adults (median age range 24–27 years), with predominantly females in HG contexts, and males in AC contexts. Overall intra-operative mortality was 0.2%.ConclusionOur findings contribute to existing knowledge of the nature of anaesthetic provision in humanitarian settings, while demonstrating the value of high-quality, routine data collection at scale in this sector. Further evaluation of perioperative outcomes associated with different models of humanitarian anaesthetic provision is required.
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Topak, Özgün E. "Humanitarian and Human Rights Surveillance: The Challenge to Border Surveillance and Invisibility?" Surveillance & Society 17, no. 3/4 (September 7, 2019): 382–404. http://dx.doi.org/10.24908/ss.v17i3/4.10779.
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The European border regime has traditionally rested on the hidden surveillance activities of border authorities, which have contributed to human rights violations (including “push-back” and “left-to-die” practices) and a rising migrant death toll. Recently a number of humanitarian and activist organizations, including Migrant Offshore Aid Station (MOAS), Médecins Sans Frontières (MSF), Sea-Watch, and WatchTheMed, have organized to aid migrants in distress at sea using surveillance technologies, ranging from drones to GPS. By doing so, they presented a challenge to the European border surveillance regime. In dialogue with the concept of countersurveillance, this paper introduces the concepts of humanitarian surveillance and human rights surveillance and deploys them to examine and categorize the activities of MOAS, MSF, Sea-Watch, and WatchTheMed. Humanitarian surveillance narrowly focuses on aiding victims of surveillance without problematizing the logic and hierarchies of surveillance, while human rights surveillance operates as a form of countersurveillance; it aims to protect and advance the human rights of victims of surveillance and expose human rights violations committed by authorities through opposing the hierarchies of surveillance. The paper shows how civilian groups incorporate elements of humanitarian and human rights surveillance in their activities at varying levels and discusses the extent to which they challenge the European border surveillance regime.
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Bullens, M., A. de Cerqueira Melo, S. Raziq, J. Lee, G. G. Khalid, S. N. Khan, A. Zada, et al. "Antibiotic resistance in patients with urinary tract infections in Pakistan." Public Health Action 12, no. 1 (March 21, 2022): 48–52. http://dx.doi.org/10.5588/pha.21.0071.
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BACKGROUND: The level of antibiotic resistance of pathogens causing uncomplicated urinary tract infections (UTIs) is increasing. The 2017–2018 GLASS (Global Antimicrobial Resistance and Use Surveillance System) report indicated >70% resistance to ceftriaxone and ciprofloxacin in Escherichia coli in Pakistan.METHODS: A prospective study was conducted in the Médecins Sans Frontières (MSF) supported Timurgara District Hospital, Timurgara, Pakistan, from September 2017 to December 2018. Women aged 18–65 years presenting to the Emergency Department with symptoms of uncomplicated UTI (cystitis/pyelonephritis) were invited to participate. We conducted microbiological culture and sensitivity testing for samples with positive dipstick or nitrite test.RESULTS: Of the 200 patients who participated, 109 (54.5%) were diagnosed with pyelonephritis and 91 (45.5%) with cystitis. Forty-three samples (21.5%) were culture-positive: E. coli was isolated in 27 samples, Enterococcus spp. in 7 and Klebsiella pneumoniae in 6. Overall resistance to ciprofloxacin was observed in 51.8% of E. coli isolates, and ceftriaxone resistance in 66.7% of E. coli isolates and in 33.3% of K. pneumoniae. Resistance to fosfomycin was low (one E. coli isolate).CONCLUSIONS: This study found resistance to first- and second-line antibiotics for treating UTIs as per the MSF protocol. Heightened awareness and potential changes to local prescription practices are necessary to curb the spread of antimicrobial resistance pathogens causing UTIs.
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Das, Mrinalini, Dileep Pasupuleti, Srinivasa Rao, Stacy Sloan, Homa Mansoor, Stobdan Kalon, Farah Naz Hossain, Gabriella Ferlazzo, and Petros Isaakidis. "GeneXpert and Community Health Workers Supported Patient Tracing for Tuberculosis Diagnosis in Conflict-Affected Border Areas in India." Tropical Medicine and Infectious Disease 5, no. 1 (December 21, 2019): 1. http://dx.doi.org/10.3390/tropicalmed5010001.
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Médecins Sans Frontières (MSF) has been providing diagnosis and treatment for patients with tuberculosis (TB) via mobile clinics in conflict-affected border areas of Chhattisgarh, India since 2009. The study objectives were to determine the proportion of patients diagnosed with TB and those who were lost-to-follow-up (LTFU) prior to treatment initiation among patients with presumptive TB between April 2015 and August 2018. The study also compared bacteriological confirmation and pretreatment LTFU during two time periods: a) April 2015–August 2016 and b) April 2017–August 2018 (before and after the introduction of GeneXpert as a first diagnostic test). Community health workers (CHW) supported patient tracing. This study was a retrospective analysis of routine program data. Among 1042 patients with presumptive TB, 376 (36%) were diagnosed with TB. Of presumptive TB patients, the pretreatment LTFU was 7%. Upon comparing the two time-periods, bacteriological confirmation increased from 20% to 33%, while pretreatment LTFU decreased from 11% to 4%. TB diagnosis with GeneXpert as the first diagnostic test and CHW-supported patient tracing in a mobile-clinic model of care shows feasibility for replication in similar conflict-affected, hard to reach areas.
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Abidi, Hella, Sander de Leeuw, and Wout Dullaert. "Performance management practices in humanitarian organisations." Journal of Humanitarian Logistics and Supply Chain Management 10, no. 2 (April 15, 2020): 125–68. http://dx.doi.org/10.1108/jhlscm-05-2019-0036.
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PurposeWe examine how design and implementation practices for supply chain performance management that have proven successful in commercial organisations apply to humanitarian organisations (HOs) to guide the process of designing and implementing performance management in humanitarian organisations.Design/methodology/approachWe identify from the literature ten successful practices regarding the design and implementation of supply chain performance management in commercial businesses. We apply these, using action research over a four-year period, at Médecins sans Frontières (MSF) Belgium and draw conclusions from this.FindingsWe find that tools and techniques, such as workshops and technical sheets, are essential in designing and implementing supply chain performance measurement projects at HOs. Furthermore, making a link to an IT project is crucial when implementing performance measurement systems at HOs. Overall, our case study shows that performance management practices used in business can be applied and are relevant for humanitarian supply chains.Originality/valuePrevious research has argued that there are few empirical studies in the domain of performance management at humanitarian organisations. To the best of our knowledge, this paper is the first to provide a longitudinal understanding of the design and implementation of supply chain performance measurement at HOs.
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Trelles, Miguel, Barclay T. Stewart, Hamayoun Hemat, Masood Naseem, Sattar Zaheer, Mutallib Zakir, Edris Adel, Catherine Van Overloop, and Adam L. Kushner. "Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015." Surgery 160, no. 5 (November 2016): 1414–21. http://dx.doi.org/10.1016/j.surg.2016.05.024.
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Fonseca, M., A. Abdi, J. Karsten, A. Lenglet, C. Kamau, J. Fernhout, A. Semple, V. Burzio, and T. Housen. "Antibiotic Resistance (ABR) in Neonates with Suspected Sepsis admitted to a Médecins Sans Frontières (MSF) supported Medium Care Unit in Quetta, Pakistan." International Journal of Infectious Diseases 73 (August 2018): 123–24. http://dx.doi.org/10.1016/j.ijid.2018.04.3696.
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Kuehne, Anna, Elburg van Boetzelaer, Prince Alfani, Adolphe Fotso, Hitham Elhammali, Tom Khamala, Trygve Thorson, et al. "Health of migrants, refugees and asylum seekers in detention in Tripoli, Libya, 2018-2019: Retrospective analysis of routine medical programme data." PLOS ONE 16, no. 6 (June 4, 2021): e0252460. http://dx.doi.org/10.1371/journal.pone.0252460.
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Libya is a major transit and destination country for international migration. UN agencies estimates 571,464 migrants, refugees and asylum seekers in Libya in 2021; among these, 3,934 people are held in detention. We aimed to describe morbidities and water, hygiene, and sanitation (WHS) conditions in detention in Tripoli, Libya. We conducted a retrospective analysis of data collected between July 2018 and December 2019, as part of routine monitoring within an Médecins Sans Frontières (MSF) project providing healthcare and WHS support for migrants, refugees and asylum seekers in some of the official detention centres (DC) in Tripoli. MSF had access to 1,630 detainees in eight different DCs on average per month. Only one DC was accessible to MSF every single month. The size of wall openings permitting cell ventilation failed to meet minimum standards in all DCs. Minimum standards for floor space, availability of water, toilets and showers were frequently not met. The most frequent diseases were acute respiratory tract infections (26.9%; 6,775/25,135), musculoskeletal diseases (24.1%; 6,058/25,135), skin diseases (14.1%; 3,538/25,135) and heartburn and reflux (10.0%; 2,502/25,135). Additionally, MSF recorded 190 cases of violence-induced wounds and 55 cases of sexual and gender-based violence. During an exhaustive nutrition screening in one DC, linear regression showed a reduction in mid-upper arm circumference (MUAC) of 2.5mm per month in detention (95%-CI 1.3–3.7, p<0.001). Detention of men, women and children continues to take place in Tripoli. Living conditions failed to meet minimum requirements. Health problems diagnosed at MSF consultations reflect the living conditions and consist largely of diseases related to overcrowding, lack of water and ventilation, and poor diet. Furthermore, every month that people stay in detention increases their risk of malnutrition. The documented living conditions and health problems call for an end of detention and better protection of migrants, refugees and asylum seekers in Libya.
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Jobanputra, Kiran, Jane Greig, Ganesh Shankar, Eric Perakslis, Ronald Kremer, Jay Achar, and Ivan Gayton. "Electronic medical records in humanitarian emergencies – the development of an Ebola clinical information and patient management system." F1000Research 5 (June 23, 2016): 1477. http://dx.doi.org/10.12688/f1000research.8287.1.
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By November 2015, the West Africa Ebola epidemic had caused 28598 infections and 11299 deaths in the three countries most affected. The outbreak required rapid innovation and adaptation. Médecins sans Frontières (MSF) scaled up its usual 20-30 bed Ebola management centres (EMCs) to 100-300 beds with over 300 workers in some settings. This brought challenges in patient and clinical data management resulting from the difficulties of working safely with high numbers of Ebola patients. We describe a project MSF established with software developers and the Google Social Impact Team to develop context-adapted tools to address the challenges of recording Ebola clinical information. We share the outcomes and key lessons learned in innovating rapidly under pressure in difficult environmental conditions. Information on adoption, maintenance, and data quality was gathered through review of project documentation, discussions with field staff and key project stakeholders, and analysis of tablet data. In March 2015, a full prototype was deployed in Magburaka EMC, Sierra Leone. Inpatient data were captured on 204 clinical interactions with 34 patients from 5 March until 10 April 2015. 85 record “pairs” for 32 patients with 26 data items (temperature and symptoms) per pair were analysed. The average agreement between sources was 85%, ranging from 69% to 95% for individual variables. The time taken to deliver the product was more than that anticipated by MSF (7 months versus 6 weeks). Deployment of the tablet coincided with a dramatic drop in patient numbers and thus had little impact on patient care. We have identified lessons specific to humanitarian-technology collaborative projects and propose a framework for emergency humanitarian innovation. Time and effort is required to bridge differences in organisational culture between the technology and humanitarian worlds. This investment is essential for establishing a shared vision on deliverables, urgency, and ownership of product.
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Paryani, Roma Haresh, Vivek Gupta, Pramila Singh, Madhur Verma, Sabira Sheikh, Reeta Yadav, Homa Mansoor, et al. "Yield of Systematic Longitudinal Screening of Household Contacts of Pre-Extensively Drug Resistant (PreXDR) and Extensively Drug Resistant (XDR) Tuberculosis Patients in Mumbai, India." Tropical Medicine and Infectious Disease 5, no. 2 (May 26, 2020): 83. http://dx.doi.org/10.3390/tropicalmed5020083.
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While risk of tuberculosis (TB) is high among household contacts (HHCs) of pre-extensively drug resistant (pre-XDR) TB and XDR-TB, data on yield of systematic longitudinal screening are lacking. We aim to describe the yield of systematic longitudinal TB contact tracing among HHCs of patients with pre-XDR-TB and XDR-TB. At the Médecins Sans Frontières (MSF) clinic, Mumbai, India a cohort comprising 518 HHCs of 109 pre-XDR and XDR index cases was enrolled between January 2016 and June 2018. Regular HHC follow-ups were done till one year post treatment of index cases. Of 518 HHCs, 23 had TB (21 on TB treatment and two newly diagnosed) at the time of first visit. Of the rest, 19% HHCs had no follow-ups. Fourteen (3.5%) TB cases were identified among 400 HHCs; incidence rate: 2072/100,000 person-years (95% CI: 1227–3499). The overall yield of household contact tracing was 3% (16/518). Of 14 who were diagnosed with TB during follow-up, six had drug susceptible TB (DSTB); six had pre-XDR-TB and one had XDR-TB. Five of fourteen cases had resistance patterns concordant with their index case. In view of the high incidence of TB among HHCs of pre-XDR and XDR-TB cases, follow-up of HHCs for at least the duration of index cases’ treatment should be considered.
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Greene, Saara, Marvelous Muchenje, Jasmine Cotnam, Kristin Dunn, Peggy Frank, Valerie Nicholson, Apondi J. Odhiambo, Krista Shore, and Angela Kaida. "Learning, Doing and Teaching Together: Reflecting on our Arts Based Approach to Research, Education and Activism with and for Women Living with HIV." Engaged Scholar Journal: Community-Engaged Research, Teaching, and Learning 5, no. 2 (June 1, 2019): 263–73. http://dx.doi.org/10.15402/esj.v5i2.68350.
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Body Mapping has been used for thousands of years by people who want to achieve a better understanding of themselves, their bodies and the world they live in. Artist Jane Solomon and psychologist Jonathan Morgan transformed Body Mapping for the “Long Life Project”, during the Médecins Sans Frontières (MSF) roll-out of antiretrovirals in Khayelitsha township, South Africa in 2001. Body mapping enables participants to tell their stories in the face of intense HIV/AIDS stigma. We adapted Body Mapping for the Women, Art and Criminalizaton of HIV Non-Disclosure (WATCH) study, a community arts based research (CBR) approach to better understand the impact that Canadian laws criminalizing HIV non-disclosure have on women living with HIV. Our national team includes women living with HIV, service providers, and researchers. This reflection illustrates our collective and iterative process of learning, teaching and doing body mapping workshops with women living with HIV in Canada. We share our experiences of coming to Body Mapping as an arts-based approach to CBR, how our roles as researchers stretched to include community-based education, advocacy, and group facilitation, and how we embodied the artist-researcher identity as we disseminate our research in ways that actively engage the general public on laws criminalizing HIV nondisclosure laws vis-à-vis Body Mapping galleries.
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Alexakis, Lykourgos Christos, Anastasia Papachristou, Chiara Baruzzi, and Angeliki Konstantinou. "The Use of Interpreters in Medical Triage during a Refugee Mass-Gathering Incident in Europe." Prehospital and Disaster Medicine 32, no. 6 (July 31, 2017): 684–87. http://dx.doi.org/10.1017/s1049023x17006781.
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AbstractIntroductionDuring a refugees’ mass-gathering incident in Kos Island, Greece, Médecins Sans Frontières (MSF; Brussels, Belgium) teams provided emergency medical care. A case report of the event focusing on difficulties encountered by the interpreters during triage and emergency response was prepared.MethodsData collected during the event were reviewed from the patient’s register and qualitative interviews were obtained from the MSF interpreters involved in the response. In addition, a description of the event and a literature review were included.ResultsTotal consultations were 49 patients, mainly from Syria, with an average age of 25 years. During triage, 20 patients were tagged green with only minor injuries; 11 patients were tagged yellow, mostly due to heat exhaustion, but also a hypertensive crisis, a diabetic, a pregnant woman with abdominal pain, and a peptic ulcer exacerbation. The remaining 18 patients were tagged red and diagnosed with heat syncope, except from a case of epileptic seizures and an acute chest pain patient. Interpreters were insufficient in number to accompany each doctor and every nurse providing care during the event. In addition, they were constantly disturbed by both refugees and fellow medical team members demanding their service. Interpreters had to triage and prioritize where to go and for whom to interpret.ConclusionInterpreters are an integral part of a proper refugee reception system. They should be included in authorities planning where mass gatherings of refugees are expected. Appropriate training may be needed for interpreters to develop skills useful in mass gatherings and similar prehospital settings in order to better coordinate with the medical team.AlexakisLCPapachristouABaruzziCKonstantinouA. The use of interpreters in medical triage during a refugee mass-gathering incident in Europe. Prehosp Disaster Med. 2017;32(6):684–687.
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Schwerdtle, Patricia M., Veronique De Clerck, and Virginia Plummer. "Experiences of Ebola Survivors: Causes of Distress and Sources of Resilience." Prehospital and Disaster Medicine 32, no. 3 (February 20, 2017): 234–39. http://dx.doi.org/10.1017/s1049023x17000073.
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AbstractIntroductionAn appreciation of the experience of Ebola survivors is critical for community engagement and an effective outbreak response. Few qualitative, descriptive studies have been conducted to date that concentrate on the voices of Ebola survivors.ProblemThis study aimed to explore the experiences of Ebola survivors following the West African epidemic of 2014.MethodAn interpretive, qualitative design was selected using semi-structured interviews as the method of data collection. Data were collected in August 2015 by Médecins Sans Frontières (MSF) Belgium, for the purposes of internal evaluation. Data collection occurred at three sites in Liberia and Sierra Leone and involved 25 participants who had recovered from Ebola. Verbal consent was obtained, audio recordings were de-identified, and ethics approval was provided by Monash University (Melbourne, Australia).FindingsTwo major themes emerged from the study: “causes of distress” and “sources of resilience.” Two further sub-themes were identified from each major theme: the “multiplicity of death,” “abandonment,” “self and community protection and care,” and “coping resources and activities.” The two major themes were dominant across all three sample groups, though each survivor experienced infection, treatment, and recovery differently.ConclusionsBy identifying and mobilizing the inherent capacity of communities and acknowledging the importance of incorporating the social model of health into culturally competent outbreak responses, there is an opportunity to transcend the victimization effect of Ebola and empower communities, ultimately strengthening the response.SchwerdtlePM, De ClerckV, PlummerV. Experiences of Ebola survivors: causes of distress and sources of resilience. Prehosp Disaster Med. 2017;32(3):234–239.
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Trajano Gomes da Silva, Diogo, Kevin Ives, Jean-Francois Fesselet, James Ebdon, and Huw Taylor. "Assessment of Recommendation for the Containment and Disinfection of Human Excreta in Cholera Treatment Centers." Water 11, no. 2 (January 22, 2019): 188. http://dx.doi.org/10.3390/w11020188.
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Containment, safe handling and disinfection of human excreta in cholera treatment centers (CTC) are key to preventing the onward spread of the disease. This study compared the efficacy of three chlorine-based approaches at concentrations of 0.5%, 1%, and 2% and one hydrated lime-based (Ca(OH)2 at 30% w:v) approach. Experiments followed existing Médecins Sans Frontières (MSF) cholera guidelines. Three simulated human excreta matrices consisting of either raw municipal wastewater (4.5 liters), or raw municipal wastewater plus 1%, or 20% faecal sludge (w:v), were treated in 14 liter Oxfam® buckets containing 125 mL of chlorine solution or hydrated lime suspension. Bacterial indicators (faecal coliforms (FC) and intestinal enterococci (IE)) and viral indicator (somatic coliphages (SOMPH)) were used to determine treatment efficacy following contact times of 10, 30 and 60min. Results showed that efficacy improved as chlorine concentrations increased. No statistical differences were observed with respect to the various contact times. Overall median log removal for 0.5% chlorine were: FC (1.66), IE (1.41); SOMPH (1.28); for 1% chlorine: FC (1.98), IE (1.82); SOMPH (1.79); and for 2% chlorine: FC (2.88), IE (2.60), SOMPH (2.38). Hydrated lime (30%) provided the greatest overall log removal for bacterial indicators (FC (3.93) and IE (3.50), but not for the viral indicator, SOMPH (1.67)). These findings suggest that the use of 30% hydrated lime suspensions or 2% chlorine solutions may offer a simple public health protection measure for the containment, safe handling, and disinfection of human excreta during humanitarian emergencies.
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van Boetzelaer, Elburg, Adolphe Fotso, Ilina Angelova, Geke Huisman, Trygve Thorson, Hassiba Hadj-Sahraoui, Ronald Kremer, and Anna Kuehne. "Health conditions of migrants, refugees and asylum seekers on search and rescue vessels on the central Mediterranean Sea, 2016–2019: a retrospective analysis." BMJ Open 12, no. 1 (January 2022): e053661. http://dx.doi.org/10.1136/bmjopen-2021-053661.
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ObjectivesThis study will contribute to the systematic epidemiological description of morbidities among migrants, refugees and asylum seekers when crossing the Mediterranean Sea.SettingSince 2015, Médecins sans Frontières (MSF) has conducted search and rescue activities on the Mediterranean Sea to save lives, provide medical services, to witness and to speak out.ParticipantsBetween November 2016 and December 2019, MSF rescued 22 966 migrants, refugees and asylum seekers.Primary and secondary outcome measuresWe conducted retrospective data analysis of data collected between January 2016 and December 2019 as part of routine monitoring of the MSF’s healthcare services for migrants, refugees and asylum seekers on two search and rescue vessels.ResultsMSF conducted 12 438 outpatient consultations and 853 sexual and reproductive health consultations (24.9% of female population, 853/3420) and documented 287 consultations for sexual and gender-based violence (SGBV). The most frequently diagnosed health conditions among children aged 5 years or older and adults were skin conditions (30.6%, 5475/17 869), motion sickness (28.6%, 5116/17 869), headache (15.4%, 2 748/17 869) and acute injuries (5.7%, 1013/17 869). Of acute injuries, 44.7% were non-violence-related injuries (453/1013), 30.1% were fuel burns (297/1013) and 25.4% were violence-related injuries (257/1013).ConclusionThe limited testing and diagnostics capacity of the outpatient department, space limitations, stigma and the generally short length of stay of migrants, refugees and asylum seekers on the ships have likely led to an underestimation of morbidities, including mental health conditions and SGBV. The main diagnoses on board were directly related to journey on land and sea and stay in Libya. We conclude that this population may be relatively young and healthy but displays significant journey-related illnesses and includes migrants, refugees and asylum seekers who have suffered significant violence during their transit and need urgent access to essential services and protection in a place of safety on land.
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Jobanputra, Kiran, Jane Greig, Ganesh Shankar, Eric Perakslis, Ronald Kremer, Jay Achar, and Ivan Gayton. "Electronic medical records in humanitarian emergencies – the development of an Ebola clinical information and patient management system." F1000Research 5 (September 30, 2016): 1477. http://dx.doi.org/10.12688/f1000research.8287.2.
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By November 2015, the West Africa Ebola epidemic had caused 28598 infections and 11299 deaths in the three countries most affected. The outbreak required rapid innovation and adaptation. Médecins sans Frontières (MSF) scaled up its usual 20-30 bed Ebola management centres (EMCs) to 100-300 beds with over 300 workers in some settings. This brought challenges in patient and clinical data management resulting from the difficulties of working safely with high numbers of Ebola patients. We describe a project MSF established with software developers and the Google Social Impact Team to develop context-adapted tools to address the challenges of recording Ebola clinical information. We share the outcomes and key lessons learned in innovating rapidly under pressure in difficult environmental conditions. Information on adoption, maintenance, and data quality was gathered through review of project documentation, discussions with field staff and key project stakeholders, and analysis of tablet data. In March 2015, a full prototype was deployed in Magburaka EMC, Sierra Leone. Inpatient data were captured on 204 clinical interactions with 34 patients from 5 March until 10 April 2015. Data continued to also be recorded on paper charts, creating theoretically identical record “pairs” on paper and tablet. 85 record pairs for 32 patients with 26 data items (temperature and symptoms) per pair were analysed. The average agreement between sources was 85%, ranging from 69% to 95% for individual variables. The time taken to deliver the product was more than that anticipated by MSF (7 months versus 6 weeks). Deployment of the tablet coincided with a dramatic drop in patient numbers and thus had little impact on patient care. We have identified lessons specific to humanitarian-technology collaborative projects and propose a framework for emergency humanitarian innovation. Time and effort is required to bridge differences in organisational culture between the technology and humanitarian worlds. This investment is essential for establishing a shared vision on deliverables, urgency, and ownership of product.
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Jobanputra, Kiran, Jane Greig, Ganesh Shankar, Eric Perakslis, Ronald Kremer, Jay Achar, and Ivan Gayton. "Electronic medical records in humanitarian emergencies – the development of an Ebola clinical information and patient management system." F1000Research 5 (February 23, 2017): 1477. http://dx.doi.org/10.12688/f1000research.8287.3.
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By November 2015, the West Africa Ebola epidemic had caused 28598 infections and 11299 deaths in the three countries most affected. The outbreak required rapid innovation and adaptation. Médecins sans Frontières (MSF) scaled up its usual 20-30 bed Ebola management centres (EMCs) to 100-300 beds with over 300 workers in some settings. This brought challenges in patient and clinical data management resulting from the difficulties of working safely with high numbers of Ebola patients. We describe a project MSF established with software developers and the Google Social Impact Team to develop context-adapted tools to address the challenges of recording Ebola clinical information. We share the outcomes and key lessons learned in innovating rapidly under pressure in difficult environmental conditions. Information on adoption, maintenance, and data quality was gathered through review of project documentation, discussions with field staff and key project stakeholders, and analysis of tablet data. In March 2015, a full prototype was deployed in Magburaka EMC, Sierra Leone. Inpatient data were captured on 204 clinical interactions with 34 patients from 5 March until 10 April 2015. Data continued to also be recorded on paper charts, creating theoretically identical record “pairs” on paper and tablet. 83 record pairs for 33 patients with 22 data items (temperature and symptoms) per pair were analysed. The overall Kappa coefficient for agreement between sources was 0.62, but reduced to 0.59 when rare bleeding symptoms were excluded, indicating moderate to good agreement. The time taken to deliver the product was more than that anticipated by MSF (7 months versus 6 weeks). Deployment of the tablet coincided with a dramatic drop in patient numbers and thus had little impact on patient care. We have identified lessons specific to humanitarian-technology collaborative projects and propose a framework for emergency humanitarian innovation. Time and effort is required to bridge differences in organisational culture between the technology and humanitarian worlds. This investment is essential for establishing a shared vision on deliverables, urgency, and ownership of product.
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Kohler, Stefan, Norman Sitali, and Nicolas Paul. "A Framework for Assessing Import Costs of Medical Supplies and Results for a Tuberculosis Program in Karakalpakstan, Uzbekistan." Health Data Science 2021 (August 26, 2021): 1–13. http://dx.doi.org/10.34133/2021/9813732.
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Background. Import of medical supplies is common, but limited knowledge about import costs and their structure introduces uncertainty to budget planning, cost management, and cost-effectiveness analysis of health programs. We aimed to estimate the import costs of a tuberculosis (TB) program in Uzbekistan, including the import costs of specific imported items. Methods. We developed a framework that applies costing and cost accounting to import costs. First, transport costs, customs-related costs, cargo weight, unit weights, and quantities ordered were gathered for a major shipment of medical supplies from the Médecins Sans Frontières (MSF) Procurement Unit in Amsterdam, the Netherlands, to a TB program in Karakalpakstan, Uzbekistan, in 2016. Second, air freight, land freight, and customs clearance cost totals were estimated. Third, total import costs were allocated to different cargos (standard, cool, and frozen), items (e.g., TB drugs), and units (e.g., one tablet) based on imported weight and quantity. Data sources were order invoices, waybills, the local MSF logistics department, and an MSF standard product list. Results. The shipment contained 1.8 million units of 85 medical items of standard, cool, and frozen cargo. The average import cost for the TB program was 9.0% of the shipment value. Import cost varied substantially between cargos (8.9–28% of the cargo value) and items (interquartile range 4.5–35% of the item value). The largest portion of the total import cost was caused by transport (82–99% of the cargo import cost) and allocated based on imported weight. Ten (14%) of the 69 items imported as standard cargo were associated with 85% of the standard cargo import cost. Standard cargo items could be grouped based on contributing to import costs predominantly through unit weight (e.g., fluids), imported quantity (e.g., tablets), or the combination of unit weight and imported quantity (e.g., items in powder form). Conclusion. The cost of importing medical supplies to a TB program in Karakalpakstan, Uzbekistan, was sizable, variable, and driven by a subset of imported items. The framework used to measure and account import costs can be adapted to other health programs.
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Marquez, Lara K., Antoine Chaillon, Kyi Pyar Soe, Derek C. Johnson, Jean-Marc Zosso, Andrea Incerti, Anne Loarec, et al. "Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar." BMJ Global Health 6, no. 2 (February 2021): e004181. http://dx.doi.org/10.1136/bmjgh-2020-004181.
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IntroductionOver half of those hepatitis C virus (HCV)/HIV coinfected live in low-income and middle-income countries, and many remain undiagnosed or untreated. In 2016, Médecins Sans Frontières (MSF) established a direct-acting antiviral (DAA) treatment programme for people HCV/HIV coinfected in Myanmar. The purpose of our study was to evaluate the real-world cost and cost-effectiveness of this programme, and potential cost-effectiveness if implemented by the Ministry of Health (MoH).MethodsCosts (patient-level microcosting) and treatment outcomes were collected from the MSF prospective cohort study in Dawei, Myanmar. A Markov model was used to assess cost-effectiveness of the programme compared with no HCV treatment from a health provider perspective. Estimated lifetime and healthcare costs (in 2017 US$) and health outcomes (in disability-adjusted life-years (DALYs)) were simulated to calculate the incremental cost-effectiveness ratio (ICER), compared with a willingness-to-pay threshold of per capita Gross Domestic Product in Myanmar ($1250). We evaluated cost-effectiveness with updated quality-assured generic DAA prices and potential cost-effectiveness of a proposed simplified treatment protocol with updated DAA prices if implemented by the MoH.ResultsFrom November 2016 to October 2017, 122 with HIV/HCV-coinfected patients were treated with DAAs (46% with cirrhosis), 96% (n=117) achieved sustained virological response. Mean treatment costs were $1229 (without cirrhosis) and $1971 (with cirrhosis), with DAA drugs being the largest contributor to cost. Compared with no treatment, the program was cost-effective (ICER $634/DALY averted); more so with updated prices for quality-assured generic DAAs (ICER $488/DALY averted). A simplified treatment protocol delivered by the MoH could be cost-effective if associated with similar outcomes (ICER $316/DALY averted).ConclusionsUsing MSF programme data, the DAA treatment programme for HCV among HIV-coinfected individuals is cost-effective in Myanmar, and even more so with updated DAA prices. A simplified treatment protocol could enhance cost-effectiveness if further rollout demonstrates it is not associated with worse treatment outcomes.
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Siddiqui, M. Ruby, Andrew Willis, Karla Bil, Jatinder Singh, Eric Mukomena Sompwe, and Cono Ariti. "Adherence to Artemisinin Combination Therapy for the treatment of uncomplicated malaria in the Democratic Republic of the Congo." F1000Research 4 (February 24, 2015): 51. http://dx.doi.org/10.12688/f1000research.6122.1.
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Between 2011 and 2013 the number of recorded malaria cases had more than doubled, and between 2009 and 2013 had increased almost 4-fold in MSF-OCA (Médecins sans Frontières – Operational Centre Amsterdam) programmes in the Democratic Republic of the Congo (DRC). The reasons for this rise are unclear. Incorrect intake of Artemisinin Combination Therapy (ACT) could result in failure to treat the infection and potential recurrence. An adherence study was carried out to assess whether patients were completing the full course of ACT.One hundred and eight malaria patients in Shamwana, Katanga province, DRC were visited in their households the day after ACT was supposed to be completed. They were asked a series of questions about ACT administration and the blister pack was observed (if available).Sixty seven (62.0%) patients were considered probably adherent. This did not take into account the patients that vomited or spat their pills or took them at the incorrect time of day, in which case adherence dropped to 46 (42.6%). The most common reason that patients gave for incomplete/incorrect intake was that they were vomiting or felt unwell (10 patients (24.4%), although the reasons were not recorded for 22 (53.7%) patients). This indicates that there may be poor understanding of the importance of completing the treatment or that the side effects of ACT were significant enough to over-ride the pharmacy instructions.Adherence to ACT was poor in this setting. Health education messages emphasising the need to complete ACT even if patients vomit doses, feel unwell or their health conditions improve should be promoted.
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Siddiqui, M. Ruby, Andrew Willis, Karla Bil, Jatinder Singh, Eric Mukomena Sompwe, and Cono Ariti. "Adherence to Artemisinin Combination Therapy for the treatment of uncomplicated malaria in the Democratic Republic of the Congo." F1000Research 4 (April 8, 2015): 51. http://dx.doi.org/10.12688/f1000research.6122.2.
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Between 2011 and 2013 the number of recorded malaria cases had more than doubled, and between 2009 and 2013 had increased almost 4-fold in MSF-OCA (Médecins sans Frontières – Operational Centre Amsterdam) programmes in the Democratic Republic of the Congo (DRC). The reasons for this rise are unclear. Incorrect intake of Artemisinin Combination Therapy (ACT) could result in failure to treat the infection and potential recurrence. An adherence study was carried out to assess whether patients were completing the full course of ACT.One hundred and eight malaria patients in Shamwana, Katanga province, DRC were visited in their households the day after ACT was supposed to be completed. They were asked a series of questions about ACT administration and the blister pack was observed (if available).Sixty seven (62.0%) patients were considered probably adherent. This did not take into account the patients that vomited or spat their pills or took them at the incorrect time of day, in which case adherence dropped to 46 (42.6%). The most common reason that patients gave for incomplete/incorrect intake was that they were vomiting or felt unwell (10 patients (24.4%), although the reasons were not recorded for 22 (53.7%) patients). This indicates that there may be poor understanding of the importance of completing the treatment or that the side effects of ACT were significant enough to over-ride the pharmacy instructions.Adherence to ACT was poor in this setting. Health education messages emphasising the need to complete ACT even if patients vomit doses, feel unwell or their health conditions improve should be promoted.
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Das, M., F. Mamnoon, H. Mansoor, A. C. Meneguim, P. Singh, I. Shah, S. Ravi, et al. "New TB drugs for the treatment of children and adolescents with rifampicin-resistant TB in Mumbai, India." International Journal of Tuberculosis and Lung Disease 24, no. 12 (December 1, 2020): 1265–71. http://dx.doi.org/10.5588/ijtld.20.0165.
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SETTING: Médecins Sans Frontières (MSF) clinic in Mumbai, India.OBJECTIVE: To determine the final treatment outcomes, culture conversion and adverse events (AEs) during treatment among children and adolescents (0–19 years) with rifampicin-resistant tuberculosis (RR-TB) who received ambulatory injectable-free treatment, including bedaquiline (BDQ) and/or delamanid (DLM) during September 2014–January 2020.DESIGN: This was a retrospective cohort study based on review of routinely collected programme data.RESULTS: Twenty-four patients were included; the median age was 15.5 years (min-max 3–19) and 15 (63%) were females. None were HIV-coinfected. All had fluoroquinolone resistance. Twelve received treatment, including BDQ and DLM, 11 received DLM and one BDQ. The median exposure to BDQ (n = 13) and DLM (n = 23) was 82 (IQR 80–93) and 82 (IQR 77–96) weeks, respectively. Seventeen (94%) patients with positive culture at baseline (n = 18) had negative culture during treatment; median time for culture-conversion was 7 weeks (IQR 5–11). Twenty-three (96%) had successful treatment outcomes: cured (n = 16) or completed treatment (n = 7); one died. Eleven (46%) had 17 episodes of AEs. Two of 12 serious AEs were associated with new drugs (QTcF >500 ms).CONCLUSION: Based on one of the largest global cohorts of children and adolescents to receive new TB drugs, this study has shown that injectable-free regimens containing BDQ and/or DLM on ambulatory basis were effective and well-tolerated among children and adolescents and should be made routinely accessible to these vulnerable groups.
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Ansbro, Éimhín, Sylvia Garry, Veena Karir, Amulya Reddy, Kiran Jobanputra, Taissir Fardous, and Zia Sadique. "Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study." Health Policy and Planning 35, no. 8 (July 4, 2020): 931–40. http://dx.doi.org/10.1093/heapol/czaa050.
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Abstract The Syrian conflict has caused enormous displacement of a population with a high non-communicable disease (NCD) burden into surrounding countries, overwhelming health systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the response. Cost data, which are currently lacking, may support programme adaptation and system scale up of such NCD services. This descriptive costing study from the provider perspective explored financial costs of the MSF NCD programme. We estimated annual total, per patient and per consultation costs for 2015–17 using a combined ingredients-based and step-down allocation approach. Data were collected via programme budgets, facility records, direct observation and informal interviews. Scenario analyses explored the impact of varying procurement processes, consultation frequency and task sharing. Total annual programme cost ranged from 4 to 6 million International Dollars (INT$), increasing annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to 1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209 to 253 (2015–17). Annual cost increases reflected growing patient load and increasing service complexity throughout 2015–17. A scenario importing all medications cut total costs by 31%, while negotiating importation of high-cost items offered 13% savings. Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more sensitive to reducing clinical review frequency than to task sharing review to nurses. Over 1000 extra patients could be enrolled without additional staffing cost if care delivery was restructured. Total costs significantly exceeded costs reported for NCD care in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or restructuring consultation models could confer cost savings or facilitate cohort expansion. Cost effectiveness studies of adapted models are recommended.
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Van Boetzelaer, Elburg, Samiur Chowdhury, Berhe Etsay, Abu Faruque, Annick Lenglet, Anna Kuehne, Isidro Carrion-Martin, et al. "Evaluation of community based surveillance in the Rohingya refugee camps in Cox’s Bazar, Bangladesh, 2019." PLOS ONE 15, no. 12 (December 23, 2020): e0244214. http://dx.doi.org/10.1371/journal.pone.0244214.
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Background Following an influx of an estimated 742,000 Rohingya refugees in Bangladesh, Médecins sans Frontières (MSF) established an active indicator-based Community Based Surveillance (CBS) in 13 sub-camps in Cox’s Bazar in August 2017. Its objective was to detect epidemic prone diseases early for rapid response. We describe the surveillance, alert and response in place from epidemiological week 20 (12 May 2019) until 44 (2 November 2019). Methods Suspected cases were identified through passive health facility surveillance and active indicator-based CBS. CBS-teams conducted active case finding for suspected cases of acute watery diarrhea (AWD), acute jaundice syndrome (AJS), acute flaccid paralysis (AFP), dengue, diphtheria, measles and meningitis. We evaluate the following surveillance system attributes: usefulness, Positive Predictive Value (PPV), timeliness, simplicity, flexibility, acceptability, representativeness and stability. Results Between epidemiological weeks 20 and 44, an average of 97,340 households were included in the CBS per surveillance cycle. Household coverage reached over 85%. Twenty-one RDT positive cholera cases and two clusters of AWD were identified by the CBS and health facility surveillance that triggered the response mechanism within 12 hours. The PPV of the CBS varied per disease between 41.7%-100%. The CBS required 354 full-time staff in 10 different roles. The CBS was sufficiently flexible to integrate dengue surveillance. The CBS was representative of the population in the catchment area due to its exhaustive character and high household coverage. All households consented to CBS participation, showing acceptability. Discussion The CBS allowed for timely response but was resource intensive. Disease trends identified by the health facility surveillance and suspected diseases trends identified by CBS were similar, which might indicate limited additional value of the CBS in a dense and stable setting such as Cox’s Bazar. Instead, a passive community-event-based surveillance mechanism combined with health facility-based surveillance could be more appropriate.
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Kaelen, Sanne, Wilma van den Boogaard, Umberto Pellecchia, Sofie Spiers, Caroline De Cramer, Gwennin Demaegd, Edouard Fouqueray, et al. "How to bring residents’ psychosocial well-being to the heart of the fight against Covid-19 in Belgian nursing homes—A qualitative study." PLOS ONE 16, no. 3 (March 26, 2021): e0249098. http://dx.doi.org/10.1371/journal.pone.0249098.
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Background Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. Methods A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. Results NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. Conclusion This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.
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Nyang'wa, Bern-Thomas, Frank Kloprogge, David A. J. Moore, Amaya Bustinduy, Ilaria Motta, Catherine Berry, and Geraint R. Davies. "Population pharmacokinetics and pharmacodynamics of investigational regimens’ drugs in the TB-PRACTECAL clinical trial (the PRACTECAL-PKPD study): a prospective nested study protocol in a randomised controlled trial." BMJ Open 11, no. 9 (September 2021): e047185. http://dx.doi.org/10.1136/bmjopen-2020-047185.
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Introduction Drug-resistant tuberculosis (TB) remains a global health threat, with little over 50% of patients successfully treated. Novel regimens like the ones being studied in the TB-PRACTECAL trial are urgently needed. Understanding anti-TB drug exposures could explain the success or failure of these trial regimens. We aim to study the relationship between the patients’ exposure to anti-TB drugs in TB-PRACTECAL investigational regimens and their treatment outcomes. Methods and analysis Adults with multidrug-resistant TB randomised to investigational regimens in TB-PRACTECAL will be recruited to a nested pharmacokinetic-pharmacodynamic (PKPD) study. Venous blood samples will be collected at 0, 2 and 23 hours postdose on day 1 and 0, 6.5 and 23 hours postdose during week 8 to quantify drug concentrations in plasma. Trough samples will be collected during week 12, 16, 20 and 24 visits. Opportunistic samples will be collected during weeks 32 and 72. Drug concentrations will be quantified using liquid chromatography-tandem mass spectrometry. Sputum samples will be collected at baseline, monthly to week 24 and then every 2 months to week 108 for MICs and bacillary load quantification. Full blood count, urea and electrolytes, liver function tests, lipase, ECGs and ophthalmology examinations will be conducted at least monthly during treatment. PK and PKPD models will be developed for each drug with nonlinear mixed effects methods. Optimal dosing will be investigated using Monte-Carlo simulations. Ethics and dissemination The study has been approved by the Médecins sans Frontières (MSF) Ethics Review Board, the LSHTM Ethics Committee, the Belarus RSPCPT ethics committee and PharmaEthics and the University of Witwatersrand Human Research ethics committee in South Africa. Written informed consent will be obtained from all participants. The study results will be shared with public health authorities, presented at scientific conferences and published in a peer-reviewed journal. Trial registration number NCT04081077; Pre-results.
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Dibari, Filippo, Paluku Bahwere, Isabelle Le Gall, Saul Guerrero, David Mwaniki, and Andrew Seal. "A qualitative investigation of adherence to nutritional therapy in malnourished adult AIDS patients in Kenya." Public Health Nutrition 15, no. 2 (February 4, 2011): 316–23. http://dx.doi.org/10.1017/s1368980010003435.
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AbstractObjectiveTo understand factors affecting the compliance of malnourished, HIV-positive adults with a nutritional protocol using ready-to-use therapeutic food (RUTF; Plumpy'nut®).DesignQualitative study using key informant interviews, focus group discussions and direct observations.SettingMinistry of Health HIV/programme supported by Médecins Sans Frontièrs (MSF) in Nyanza Province, Kenya.SubjectsAdult patients (n 46) currently or previously affected by HIV-associated wasting and receiving anti-retroviral therapy, their caregivers (n 2) and MoH/MSF medical employees (n 8).ResultsThirty-four out of forty-six patients were receiving RUTF (8360 kJ/d) at the time of the study and nineteen of them were wasted (BMI < 17 kg/m2). Six of the thirteen wasted out-patients came to the clinic without a caregiver and were unable to carry their monthly provision (12 kg) of RUTF home because of physical frailty. Despite the patients’ enthusiasm about their weight gain and rapid resumption of labour activities, the taste of the product, diet monotony and clinical conditions associated with HIV made it impossible for half of them to consume the daily prescription. Sharing the RUTF with other household members and mixing with other foods were common. Staff training did not include therapeutic dietetic counselling.ConclusionsThe level of reported compliance with the prescribed dose of RUTF was low. An improved approach to treating malnourished HIV-positive adults in limited resource contexts is needed and must consider strategies to support patients without a caregiver, development of therapeutic foods more suited to adult taste, specific dietetic training for health staff and the provision of liquid therapeutic foods for severely ill patients.
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Conan, Nolwenn, Cyrus P. Paye, Reinaldo Ortuno, Alexander Chijuwa, Brown Chiwandira, Eric Goemaere, Daniela Belen Garone, Rebecca M. Coulborn, Menard Chihana, and David Maman. "What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi." PLOS ONE 16, no. 4 (April 22, 2021): e0248410. http://dx.doi.org/10.1371/journal.pone.0248410.
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Introduction The Malawi Ministry of Health (MoH) has been in collaboration with Médecins sans Frontières (MSF) to increase access to quality HIV care through decentralization of antiretroviral therapy (ART) diagnosis and treatment from hospital to clinics in Nsanje District since 2011. A population-based household survey was implemented to provide information on HIV prevalence and cascade of care to inform and prioritize community-based HIV interventions in the district. Methods A cross-sectional survey was conducted between September 2016 and January 2017. Using two-stage cluster sampling, eligible adult individuals aged ≥15 years living in the selected households were asked to participate. Participants were interviewed and tested for HIV at home. Those tested HIV-positive had their HIV-RNA viral load (VL) measured, regardless of their ART status. All participants tested HIV-positive at the time of the survey were advised to report their HIV test result to the health facility of their choice that MSF was supported in the district. HIV-RNA VL results were made available in this health facility. Results Among 5,315 eligible individuals, 91.1% were included in the survey and accepted an HIV test. The overall prevalence was 12.1% (95% Confidence Interval (CI): 11.2–13.0) and was higher in women than in men: 14.0% versus 9.5%, P<0.001. Overall HIV-positive status awareness was 80.0% (95%CI: 76.4–83.1) and was associated with sex (P<0.05). Linkage to care was 78.0% (95%CI: 74.3–81.2) and participants in care 76.2% (95%CI: 72.4–79.5). ART coverage among participants aware of their HIV-positive status was 95.3% (95%CI: 92.9–96.9) and was not associated with sex (P = 0.55). Viral load suppression among participants on ART was 89.9% (95%CI: 86.6–92.4) and was not statistically different by sex (p = 0.40). Conclusions Despite encouraging results in HIV testing coverage, cascade of care, and UNAIDS targets in Nsanje District, some gap remains in the first 90, specifically among men and young adults. Enhanced community engagement and new strategies of testing, such as index testing, could be implemented to identify those who are still undiagnosed, particularly men and young adults.
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Falagara Sigala, Ioanna, William J. Kettinger, and Tina Wakolbinger. "Digitizing the field: designing ERP systems for Triple-A humanitarian supply chains." Journal of Humanitarian Logistics and Supply Chain Management 10, no. 2 (March 16, 2020): 231–60. http://dx.doi.org/10.1108/jhlscm-08-2019-0049.
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PurposeThe purpose of this study is to explore what design principles need to be considered in Enterprise Resource Planning (ERP) systems for humanitarian organizations (HOs) to enable agile, adaptive and aligned (Triple-A) humanitarian supply chain capabilities and digitize humanitarian operations.Design/methodology/approachThis study follows an embedded case study approach with a humanitarian medical relief organization, Médecins Sans Frontières (MSF), which engaged in a multiyear ERP design at its humanitarian field missions.FindingsThis research shows that ERP systems for humanitarian organizations should be designed as unique systems addressing humanitarian organizations' challenges and unique missions, their value generation processes, and resource base in an effort to improve organizational performance. This study presents 12 general design principles that are unique for humanitarian organizations. These design principles provide a high-level structure of guidance under which specific requirements can be further defined and engineered to achieve success.Research limitations/implicationsThe results of this study are based on a single case study limiting generalizability. However, the case study was analyzed and presented as an embedded case study with five autonomous subunits using different business processes and following different adoption and implementation approaches. Therefore, the findings are derived based on considerable variance reflective of humanitarian organizations beyond MSF.Practical implicationsThis study recognizes that HOs have unique routines that standard commercial ERP packages do not address easily at the field level. The primary contribution of this research is a set of design principles that consider these unique routines and guide ERP development in practice. National and international HOs that are planning to implement information systems, private companies that are trading partners of HOs as well as vendors of ERP systems that are looking for new opportunities would all benefit from this research.Originality/valueThis study fills the gap in the humanitarian literature regarding the design of ERP systems for humanitarian organizations that enable Triple–A supply chain capabilities and it advances the knowledge of the challenges of ERP design by HOs in the context of humanitarian operations.
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Das, Mrinalini, Taanya Mathur, Shilpa Ravi, Augusto C. Meneguim, Aparna Iyer, Homa Mansoor, Stobdan Kalon, et al. "Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study." PLOS ONE 16, no. 3 (March 10, 2021): e0248408. http://dx.doi.org/10.1371/journal.pone.0248408.
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Background Childhood multidrug-resistant TB (MDR-TB) still affects around 25000 children every year across the globe. Though the treatment success rates for drug-resistant TB (DR-TB) in children are better than adults, children and adolescents face unique hurdles during DR-TB (MDR-TB, Pre-XDR TB and XDR-TB) treatment. This study aimed to understand the patients, guardians and healthcare providers’ perspectives about DR-TB treatment journey of patients and caregivers. Methods This is a qualitative study involving in depth-interviews of purposively selected adolescents (n = 6), patients guardians (for children and adolescents, n = 5) and health care providers (n = 8) of Médecins Sans Frontières (MSF) clinic, Mumbai, India. In-depth face to face interviews were conducted in English or Hindi language using interview guides during September-November 2019. The interviews were audio-recorded after consent. Thematic network analysis was used to summarize textual data. ATLAS.ti (version 7) was used for analysis. Result The age of adolescent patients ranged from 15–19 years and four were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers (including clinicians- 2, DOT providers-2, counselors-2 and programme managers-2) were interviewed. The overarching theme of the analysis was: Challenging DR-TB treatment journey which consisted of four sub-themes: 1) physical-trauma, 2) emotional-trauma, 3) unavailable social-support and 4) non-adapted healthcare services. Difficulties in compounding of drugs were noted for children while adolescents shared experiences around disruption in social life due to disease and treatment. Most of the patients and caregivers experienced treatment fatigue and burnout during the DR-TB treatment. Participants during interviews gave recommendations to improve care. Discussion The TB programmes must consider the patient and family as one unit when designing the package of care for paediatric DR-TB. Child and adolescent friendly services (paediatric-formulations, age-specific counselling tools and regular interaction with patients and caregivers) will help minimizing burnout in patients and caregivers.
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Kaplunenko, Yaryna. "Psychological First Aid: Experience of International Organizations." Psychology and Psychosocial Interventions 3 (March 3, 2021): 36–41. http://dx.doi.org/10.18523/2617-2348.2020.3.36-41.
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The turbulent shocks of recent decades—man-made and natural disasters, political instability, pandemics, and military conflicts—highlight the need for psychosocial support for victims. To plan and train those who can provide it, a number of guidelines have been developed at the global and national levels, within international medical organizations that can minimize the impact of the crisis and start the recovery process. The article presents the definition of the concept of Psychological First Aid (PFA), describes the key aspects, structure, time limits, and principles of activity; a description of three leading models of first psychological assistance in the context of international medical organizations: the World Health Organization (WHO), Doctors Without Borders (Médecins Sans Frontières, MSF), and the Johns Hopkins Center for Public Health Preparedness, USA. The RAPID model of first aid and key competencies for psychosocial workers involved in helping victims are described. The principles and techniques of PFA meet four basic standards: they are based on the results of research of risks and resilience after injury; they are practical and suitable for use in the “field”; they meet the age characteristics of development; they take into account cultural differences. The chronogram of mental reactions to a stressful event and the provision of PFA to victims within international medical organizations is divided into four phases which should be taken into account in the organization of psychosocial support. The RAPID model is based on five aspects designed to alleviate acute stress: Rapport and Reflective listening; Assessment of needs; Prioritization; Intervention; Disposition. If control over bodily reactions, emotions, and thoughts in the victims are restored, the narrative of the event is completed and accompanied by appropriate reactions, emotions are accepted, self-esteem and self-confidence are restored, and a sense of the future appears, we can say that the person has successfully adapted to the traumatic event and is ready to move on.
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Dhakulkar, Shubhangi, Mrinalini Das, Narendra Sutar, Vikas Oswal, Daksha Shah, Shilpa Ravi, Dipa Vengurlekar, et al. "Treatment outcomes of children and adolescents receiving drug-resistant TB treatment in a routine TB programme, Mumbai, India." PLOS ONE 16, no. 2 (February 18, 2021): e0246639. http://dx.doi.org/10.1371/journal.pone.0246639.
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Background Childhood and adolescent drug-resistant TB (DR-TB) is one of the neglected infectious diseases. Limited evidence exists around programmatic outcomes of children and adolescents receiving DR-TB treatment. The study aimed to determine the final treatment outcomes, culture conversion rates and factors associated with unsuccessful treatment outcome in children and adolescents with DR-TB. Methods This is a descriptive study including children (0–9 years) and adolescents (10–19 years) with DR-TB were who were initiated on ambulatory based treatment between January 2017-June 2018 in Shatabdi hospital, Mumbai, India where National TB elimination programme(NTEP) Mumbai collaborates with chest physicians and Médecins Sans Frontières(MSF) in providing comprehensive care to DR-TB patients. The patients with available end-of-treatment outcomes were included. The data was censored on February 2020. Result A total of 268 patients were included; 16 (6%) of them were children (0–9 years). The median(min-max) age was 17(4–19) years and 192 (72%) were females. Majority (199, 74%) had pulmonary TB. Most (58%) had MDR-TB while 42% had fluoroquinolone-resistant TB. The median(IQR) duration of treatment (n = 239) was 24(10–25) months. Median(IQR) time for culture-conversion (n = 128) was 3(3–4) months. Of 268 patients, 166(62%) had successful end-of-treatment outcomes (cured-112; completed treatment-54). Children below 10 years had higher proportion of successful treatment outcomes (94% versus 60%) compared to adolescents. Patients with undernutrition [adjusted odds-ratio, aOR (95% Confidence Interval, 95%CI): 2.5 (1.3–4.8) or those with XDR-TB [aOR (95% CI): 4.3 (1.3–13.8)] had higher likelihood of having unsuccessful DR-TB treatment outcome. Conclusion High proportion of successful treatment outcome was reported, better than global reports. Further, the nutritional support and routine treatment follow up should be strengthened. All oral short and long regimens including systematic use of new TB drugs (Bedaquiline and Delamanid) should be rapidly scaled up in routine TB programme, especially for the paediatric and adolescent population.