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Early physical and functional rehabilitation of trauma patients in…
March 14, 2017
In Afghanistan, Doctors Without Borders/Médecins Sans Frontières (MSF) provided specialised trauma care in Kunduz Trauma Centre (KTC), including physiotherapy. In this study, we describe the development of an adapted functional score for patient outcome monitoring and document the rehabilitation care provided and patient outcomes in relation to this functional score. The study concludes that the provision of physiotherapy was feasible in this humanitarian setting, and the tailored functional score appeared to be relevant.
Fighting poor-quality medicines in low- and middle-income countries: The…
February 17, 2017
Today’s global market has multiple standards. Patients in low- and middle-income countries often receive poor-quality medicines. Despite increasing awareness about the issue and the launch of some initiatives, the divide in quality of pharmaceuticals between the North and the South remains great and insufficiently addressed. Amongst other recommendations, this editorial emphasises that there needs to be more advocacy for universal access to quality medicines. It further states that all those who are strongly “involved” with medicines should be targeted: regulators, international organisations, journalists, purchasers, prescribers, program managers, policy makers, public health actors, and the patients. It concludes by stating the fight to ensure universal access to quality medicines needs everyone’s participation, and can only be successful if grounded in common understanding.
Modelling the effect of short-course multidrug-resistant tuberculosis treatment in…
February 16, 2017
Multidrug-resistant tuberculosis (MDR-TB) is a major threat to global TB control. MDR-TB treatment regimens typically have a high pill burden, last 20 months or more and often lead to unsatisfactory outcomes. A 9–11 month regimen with seven antibiotics has shown high success rates among selected MDR-TB patients in different settings and is conditionally recommended by the World Health Organization. This study constructs a transmission-dynamic model of TB to estimate the likely impact of a shorter MDR-TB regimen when applied in a low HIV prevalence region of Uzbekistan (Karakalpakstan) with high rates of drug resistance, good access to diagnostics and a well-established community-based MDR-TB treatment programme providing treatment to around 400 patients. Based on empirical outcomes among MDR-TB patients and assuming no improvement in treatment success rates, it was concluded that shorter MDR-TB treatment regimens also have the potential to reduce transmission of resistant strains.
Clinical research in neglected tropical diseases: The challenge of…
February 15, 2017
Collaborative clinical research that addresses the health needs of low and middle-income countries (LMICs) has become more frequent recently. Such research includes therapeutic and diagnostic trials for neglected tropical diseases (NTDs), and is often conducted by non-commercial groups. Compliance with these international codes may seem a daunting task for small, non-commercial research units working in the NTD domain in LMICs, especially when they assume the role of “sponsor,” i.e., the custodian of compliance with legal and ethical frameworks. In this PLOS collection, we share the experience of clinical research on NTD-related syndromes conducted by the NIDIAG consortium (http://www.nidiag.org/) between 2010 and 2015 in Cambodia, the Democratic Republic of Congo, Indonesia, Ivory Coast, Mali, Nepal, and Sudan. This viewpoint article summarises the main lessons learnt when implementing Good Clinical (Laboratory) Practices (GCLP) in NTD clinical research.
Emergency department care for trauma patients in settings of…
February 14, 2017
Trauma is one of the leading causes of death in developing countries – where there is limited access to good quality emergency care. Doctors Without Borders/Médecins Sans Frontières (MSF) delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in a similar performance in these very different contexts. For the first time, this study supports the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs
Research ethics governance in times of Ebola
February 13, 2017
The Doctors Without Borders/Médecins Sans Frontières (MSF) ethics review board (ERB) was solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, which included epidemiological research, behavioural research, infectivity studies and clinical trials with investigational products at (very) early development stages. This article examines the MSF ERB’s experience addressing issues related to the review process and substantive ethical issues in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms.
Having noticed different standards across ethics committees (ECs), we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency, they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process.
Infection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment…
January 31, 2017
Multidrug-resistant tuberculosis (MDR TB), is a significant threat to TB control efforts. Previous prevailing views that resistance was mainly acquired through poor treatment led to decades of focus on drug-sensitive rather than drug-resistant (DR) TB. This scenario was driven by the World Health Organization’s (WHO) directly observed therapy, short course strategy. The paradigm has now shifted towards the recognition that most DR TB is transmitted and that there is a need for increased efforts to control DR TB. Yet most people with DR TB are untested and untreated, driving transmission in the community and in health systems in high-burden settings. The risk of nosocomial transmission is high for patients and staff alike. This article discusses a comprehensive approach, strategies available, and associated challenges to lower the transmission risk of MDR TB, globally. It concludes that instead of focusing on diagnosed MDR TB cases, recognition that transmission is driven largely by undiagnosed, untreated cases, both in the community and in healthcare settings, is necessary.
Feasibility of Xpert Ebola Assay in Médecins Sans Frontières…
January 30, 2017
This study assesses the feasibility and added value of using the Xpert Ebola Assay in an Ebola control program in Guinea. Several logistic and safety issues were identified and the study suggests that implementation of the Xpert Ebola Assay under programmatic conditions is feasible and represents a major advance in diagnosis of Ebola virus disease without apparent loss of assay sensitivity.
Assessing the burden of rheumatic heart disease among refugee…
January 29, 2017
A recent editorial in Lancet, advocates for a better and more universal access to healthcare for refugees landing in Europe. The arguments of equity, social justice and cost– effectiveness are clearly explained in the comment. Among the different suggestions to improve the refugees’ health, the authors invite the policy makers to opt for strategies favoring the “provision of preventive care, including primary and secondary prevention of cardiovascular disease” which “could generate savings for health–care systems by alleviating the burden of stroke, and myocardial infarction”. Building on their advice, MSF launched a Call to Action outlining the need for providing primary and secondary preventive care for acquired cardiac diseases in refugee children. The Call to Action specifies that in order to tackle the evolution of rheumatic heart disease (RHD), specific control programs based on the concurrent development of disease registers along with the consistent delivering of benzathine penicillin G injections, need to be strengthened by a decentralized echocardio–based active case finding activities, comprehensively integrated into the existing primary health care services.
Leprosy Trends at a Tertiary Care Hospital in Mumbai,…
January 28, 2017
Leprosy remains an important cause of preventable disabilities. After the advent of multidrug therapy, new leprosy cases have come down dramatically. Despite this achievement, India, which contributes
60% to the global leprosy burden, faces some challenges to eliminate the disease, including active transmission in the community and delayed diagnosis of leprosy patients. The objectives of this retrospective descriptive study were 1) to determine socio-demographic and clinical characteristics of newly diagnosed adults and children (less than 15 years) with leprosy and their trends over time (20082015) and 2) to describe the profile of surgical procedures among leprosy patients registered for reconstructive surgeries during 20062015. The study concludes that targeting children and migrants and ensuring early diagnosis and treatment initiation are essential components for leprosy elimination in an urban metropolis in India.
Adapting to the global shortage of cholera vaccines: targeted…
January 27, 2017
Shortages of vaccines for epidemic diseases, such as cholera, meningitis, and yellow fever, have become common over the past decade, hampering efforts to control outbreaks through mass reactive vaccination campaigns. Additionally, various epidemiological, political, and logistical challenges, which are poorly documented in the literature, often lead to delays in reactive campaigns, ultimately reducing the effect of vaccination. In June 2015, a cholera outbreak occurred in Juba, South Sudan, and because of the global shortage of oral cholera vaccine, authorities were unable to secure sufficient doses to vaccinate the entire at-risk population-approximately 1 million people. In this Personal View, we document the first public health use of a reduced, single-dose regimen of oral cholera vaccine, and show the details of the decision-making process and timeline. We also make recommendations to help improve reactive vaccination campaigns against cholera, and discuss the importance of new and flexible context-specific dose regimens and vaccination strategies.
Cost of hospitalisation for non-communicable diseases in India: are…
December 27, 2016
This MSF study analyses nationwide representative data collected by the National Sample Survey Organisation with an aim to estimate out-of-pocket (OOP) expenditure due to hospitalisation from NCDs in India. The study also analyses its impact on households in the country. Basis in-depth research it was concluded that strengthening of public health facilities is required at a community level for the prevention, control and management of NCDs. Promotion of generic medicines, better availability of essential drugs and possible subsidisation for the poorest quintile will be measures to consider, reducing OOP expenditure in public-sector facilities.