Medical Research

Medical Research

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

Multi-drug resistant tuberculosis (including extensively-drug resistant tuberculosis) and its treatment, has multi-dimensional effects on patients’ lives. Health-related quality of life (HRQoL) is a patient reported outcome measure, which has been defined to include physical, psychological, emotional, social well-being and role functioning and the perceptions thereof. Measuring HRQoL is important because functional capacity, well-being and the experience of illness are more important to patients than mere bacteriological cure. The aim of this study is to assess the HRQoL among multi-drug resistant tuberculosis patients in Mumbai, India and associated factors while exploring their perspectives about HRQoL. It was concluded that health related quality of life was lower among study participants than reported in healthy people, but not as low as previously reported among TB patients. With good quality care and support, patients can live a reasonably good quality of life.

Childhood acute respiratory illnesses (ARI) cause significant mortality and morbidity. It also accounts for antibiotic prescriptions and the development of resistant bacteria at the community level. This baseline study was carried out by MSF to understand current prescription practices for childhood ARI by Ministry of Health (MoH) physicians in Asansol, West Bengal. MSF plans to begin an antibiotic stewardship programme and run a new ARI clinic within Asansol District Hospital and Raniganj block primary health centre (BPHC), as part of an ongoing collaboration with the West Bengal MoH. This is the first prescription audit carried out in Asansol Health District. It essay outlines how open source methods of working could be applied to the discovery and development of new medicines. It summarises that there are many potential advantages of an open source approach, such as improved efficiency, the quality and relevance of the research, and wider participation by the scientific and patient communities; a blend of traditional and innovative financing mechanisms will have to be adopted. In order to properly evaluate the effectiveness of an open source methodology and its potential as an alternative model of drug discovery and development, we recommend that new projects be trialed and existing projects scaled up.

The KalaCORE project is a UK Department for International Development (DFID)-funded initiative to eliminate visceral leishmaniasis (VL) in Bangladesh, India, and Nepal, and to control VL in Ethiopia, South Sudan and Sudan. Aimed at improving access to early diagnosis and complete treatment, KalaCORE relies on baseline data to guide decision making around support for VL control programmes. The limited existing literature on treatment seeking and costs of VL illness points to long delays in diagnosis and treatment. However, with recent improvements to diagnostic tests and treatment regimens, the accuracy of those data is now in question. New surveys are needed to identify programmes’ priority needs for improving patient disease management and access to care. These are cross-sectional surveys of VL patients recently treated at 46 VL treatment facilities in endemic areas of Bangladesh, India, Ethiopia, and Sudan between February and September, 2016. The study concludes that despite a greater focus on the disease, VL illness is still diagnosed late and places a substantial economic burden on patients and their households. This is largely due to the financial costs incurred through wrong diagnosis and loss of income to patients and/or their caretakers.

Kamrangirchar and Hazaribagh are the largest slum area in Dhaka, Bangladesh. In 2013 Médecins Sans Frontières (MSF) started an urban healthcare program responding to needs identified amongst the factory worker population and for sexual and reproductive healthcare for young women. Little in-depth information is available on the perceptions of health and health seeking behaviour of this population. MSF conducted a qualitative study aiming to inform MSF activities and policy discussion toward better health provision for this and similar communities. It concludes that improving health in Kamrangirchar and Hazaribagh demands a comprehensive and collaborative health system, with improved access to secondary level care and referral systems. A combination of increased regulation and capacity building is necessary to improve existing pharmacy practice. Community-based mechanisms with an emphasis on health education for decision making will facilitate access to information and services, particularly for vulnerable groups.

MSF has been present in Yemen since 2007. After war broke out in 2015, MSF intervened at a referral hospital in Hajjah, an administrative area at the frontlines of the fighting and host to nearly half of the country’s estimated 2.76 million internally displaced persons (IDPs). In 2016, the hospital treated 3438 war-wounded persons, and as the conflict drags on, both host and IDP communities continue to suffer from shortages of food and clean water and a severe lack of access to quality healthcare. That includes care for the mental health (MH) of affected communities, which appears to have deteriorated. MSF collected and analysed data on all patients who received psychological support from MSF between November, 2016 and February, 2017. Further to this, the study summarises the lessons learned regarding the challenges and impact of MSFs mental health work in this context.

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