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Feature of the Month

Out of Step 2017

Two days ahead of the G20 summit in Germany, the international medical humanitarian organisation Médecins Sans Frontières (MSF) and the Stop TB Partnership released the third edition of ‘Out of Step,’ a report highlighting the need for governments to increase efforts to combat tuberculosis (TB). The report reviews TB policies and practices in 29 countries – which account for 82% of the global TB burden – and shows that countries can do much more to prevent, diagnose and treat people affected by TB.  Although TB is preventable and treatable, it remains the world deadliest infectious disease. In 2015 alone, 1.8 million people died from it. In 2015, the majority (54%) of the 10.4 million people with TB lived in the countries represented at the G20 summit. Despite its deadly toll, most countries lag behind in implementing the new tools that are available to tackle TB. Read on to know more.

Research

This collection of files includes an overview of the whole process of conducting a mortality survey and templates for concept papers, the protocol, questionnaires and consent and other related forms.

Surveys that use this standardised intersectional protocol do not require MSF Ethics Review Board (ERB) review if the Medical Director of the relevant section takes responsibility for addressing the ethics issues. The exemption criteria of the MSF ERB for standardised intersectional survey protocols must be followed. See http://fieldresearch.msf.org/msf/handle/10144/618799

Photo: Ramón Pereiro/MSF

Jai Defranciscis is an Australian nurse with a passion for paediatrics and education in resource-poor settings. Last year she joined the international medical aid organisation Médecins Sans Frontières (MSF) – also known as Doctors Without Borders – heading to South Sudan for a year, working with refugees fleeing fighting between armed groups. This is her account.

Photo: Christina Simons/MSF

Although HIV/AIDS has been anything but neglected over the last decade, opportunistic infections (OIs) are increasingly overlooked as large-scale donors shift their focus from acute care to prevention and earlier antiretroviral treatment (ART) initiation. Of these OIs, cryptococcal meningitis, a deadly invasive fungal infection, continues to affect hundreds of thousands of HIV patients with advanced disease each year and is responsible for an estimated 15%–20% of all AIDS-related deaths. Yet cryptococcal meningitis ranks amongst the most poorly funded “neglected” diseases in the world, receiving 0.2% of available relevant research and development (R&D) funding. The debate over whether or not cryptococcal disease is an NTD detracts from cryptococcal meningitis being both HIV related and also urgently needing the interventions (funding, policy drives, and drug pipelines) from which NTDs benefit. This paper calls on the global health community, PLOS NTDs, UNITAID, The Global Fund, and WHO to declare cryptococcal meningitis an NTD and press for urgent funding and policy drives to target optimisation and rollout of CrAg-screening programs.

Photo: Benoit Finck/MSF

Evidence is urgently needed from complex emergency settings to support efforts to respond to the increasing burden of diabetes mellitus (DM). Médecins Sans Frontières conducted a qualitative study of a new model of DM health care (Integrated Diabetic Clinic within an Outpatient Department [IDC-OPD]) implemented by MSF in Mweso Hospital in eastern Democratic Republic of Congo (DRC). The paper aimed to explore patient and provider perspectives on the model in order to identify factors that may support or impede it. The study concludes that the importance of community awareness of DM and the value of treatment support, including psychosocial and educational support to DM patients and their families, and culturally sensitive, low-cost dietary advice, to ensuring the adoption and maintenance of DM treatment.

Photo: MSF

Although neonatal mortality is gradually decreasing worldwide, 98% of neonatal deaths occur in low- and middle-income countries, where hospital care for sick and premature neonates is often unavailable. Médecins Sans Frontières managed eight specialised neonatal care units (SNCUs) at district level in low-resource and conflict-affected settings in seven countries to assess the performance of the MSF SNCU model across different settings in Africa and Southern Asia. The study also aimed to describe the set-up of eight SNCUs, neonate characteristics and clinical outcomes among neonates from 2012 to 2015. It was concluded that the standardised SNCU model was implemented across different contexts and showed in-patient outcomes within acceptable limits. Low-tech medical care for sick and premature neonates can and should be implemented at district hospital level in low-resource settings.

Photo: Jan Bohm/MSF

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