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Standardised Mortality Surveys

August 12, 2017

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

Educating nurses in resource-poor areas

August 11, 2017

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.

Cryptococcal Meningitis: A neglected NTD?

August 10, 2017

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.

Diabetes care in a complex humanitarian emergency setting: A…

August 09, 2017

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.

Where technology does not go: Specialised neonatal care in…

August 08, 2017

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.

Beyond ‘cure’ and ‘treatment success’: quality of life of…

June 30, 2017

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.

Antibiotic prescribing for respiratory illness in paediatric outpatients: a…

June 21, 2017

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.

Cross-sectional surveys of visceral leishmaniasis treatment seeking behaviour, diagnosis,…

June 20, 2017

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.

‘Working to stay healthy’: health seeking behaviour in two…

June 19, 2017

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.

Minds subjected to immutable violence In Yemen: A descriptive…

June 18, 2017

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.

An Open Source Pharma Roadmap

May 17, 2017

This 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 trialled and existing projects scaled up.

Recurrent tuberculosis and associated factors: A five-year countrywide study…

May 16, 2017

In Uzbekistan, despite stable and relatively high tuberculosis (TB) treatment success rates, relatively high rates of recurrent TB have recently been reported. This requires closer analysis to identify possible causes and recommend interventions to improve the situation. Using countrywide data, this nation-wide retrospective study aimed to analyse trends in recurrent TB cases and describe their associations with socio-demographic and clinical factors. The study compared recurrent TB patients with all new TB patients registered within the National TB Programme (NTP) between January 2006 and December 2010 using routinely collected data. It was concluded that despite signs of declining national TB notifications between 2006 and 2010, the relative proportion of recurrent cases appears to have increased. These findings, together with the identification of possible risk factors associated with recurrent TB, highlight various areas where Uzbekistan needs to focus its TB control efforts, particularly in light of the country’s rapidly emerging multi-drug resistant TB (MDR-TB) epidemic.

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