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Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience
No full textIn 2015, following an influx of population into Kobanê in northern Syria, Médecins Sans Frontières (MSF) in collaboration with the Kobanê Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Kobanê in 2015
The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone
No full textLittle is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone
Early safety and efficacy of the combination of bedaquiline and delamanid for the treatment of patients with drug-resistant tuberculosis in Armenia, India, and South Africa: a retrospective cohort study
No full textBedaquiline and delamanid have been approved for treatment of multidrug-resistant (MDR) tuberculosis in the past 5 years. Because of theoretical safety concerns, patients have been unable to access the two drugs in combination. Médecins Sans Frontières has supported the use of combination bedaquiline and delamanid for people with few treatment options since 2016. We describe early safety and efficacy of regimens containing the bedaquiline and delamanid combination in patients with drug-resistant tuberculosis in Yerevan, Armenia; Mumbai, India; and Khayelitsha, South Africa
Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013
No full textIn 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged <5 years). The estimated case fatality rate was 4.2% (6.1% among children aged <5 years). Spatial analysis and linear regression showed that younger children, those who did not receive care, and those living farther away from Aketi Hospital early in the epidemic had a higher risk of measles related death. Vaccination coverage prior to the outbreak was low (76%), and a delayed reactive vaccination campaign contributed to the high attack rate. We provide evidences suggesting that a comprehensive case management approach reduced measles fatality during this epidemic in rural, inaccessible resource-poor setting
'He who helps the guilty, shares the crime'? INGOs, moral narcissism and complicity in wrongdoing
No full textWe regret that this article is behind a paywall.Humanitarian organisations often work alongside those responsible for serious wrongdoing. In these circumstances, accusations of moral complicity are sometimes levelled at decision makers. These accusations can carry a strong if unfocused moral charge and are frequently the source of significant moral unease. In this paper, we explore the meaning and usefulness of complicity and its relation to moral accountability. We also examine the impact of concerns about complicity on the motivation of humanitarian staff and the risk that complicity may lead to a retreat into moral narcissism. Moral narcissism is the possibility that where humanitarian actors inadvertently become implicated in wrongdoing, they may focus more on their image as self-consciously good actors than on the interests of potential beneficiaries. Moral narcissism can be triggered where accusations of complicity are made and can slew decision making. We look at three interventions by Médecins Sans Frontières that gave rise to questions of complicity. We question its decision-guiding usefulness. Drawing on recent thought, we suggest that complicity can helpfully draw attention to the presence of moral conflict and to the way International Non-Governmental Organisations (INGOs) can be drawn into unintentional wrongdoing. We acknowledge the moral challenge that complicity presents to humanitarian staff but argue that complicity does not help INGOs make tough decisions in morally compromising situations as to whether they should continue with an intervention or pull out
Long term follow up of Noma patients after surgical, nutritional and mental health interventions at the Noma Children’s Hospital in northwest Nigeria, 2018
No full textResearch ProtocolNoma is a little understood, rapidly progressing gangrenous infection of the oral cavity, associated with a reported 90% mortality rate [1]. Noma mostly affects children under the age of five, and those who survive have severe facial disfigurements (2) and multiple physical impairments such as difficulty eating, seeing and breathing. Noma can also cause stigmatization due to these impairments [2]. The incidence of Noma is estimated to be 6.4 per 1000 children [3], and the World Health Organisation estimate that 140 000 children contract Noma each year [4]. Noma is thought to be most prevalent along the Noma belt which stretches from Senegal to Ethiopia [2], however Noma cases have recently been reported in the United Kingdom[5], United States [6], Afghanistan [7], South Korea [8] and Laos [9]. Little is known about Noma as the majority of cases live in underserved areas, difficult to reach locations, the mortality rate is high and the disease often goes undiagnosed. \ud
Noma starts as an inflammation of the gums, similar to a mouth ulcer, which then leads to the rapid destruction (one week [4]) of the jaw, lip, cheek, nose and sometimes eye [10]. During the first active stages of the disease, antibiotic treatment and wound dressing are effective forms of care, once Noma becomes inactive, patients can survive into adulthood but require extensive reconstructive surgery. The pathogenic cause of Noma is unknown [4]. Noma typifies the complex interactions between extreme poverty, severe malnutrition, poor oral hygiene practices, limited access to high quality health care [7] and co-morbidities with infections such as measles [1,2,7,11–18], malignancies, particularly leukaemia [4,11–13,16,17,19], Human Immunodeficiency Virus (HIV) [2,4–7,9,13,17–20] and Crohn’s Disease [8]. \ud
Long term outcomes of Noma treatment are difficult to ascertain due to inconsistent follow up because of the remote locations of home villages of patients and difficulties with access to health care assessments. A 2010 paper on the outcome of trismus release in Noma patients in northwest Nigeria (patients from the Noma Children’s Hospital), showed that the long term results of trismus release were poor with only 39% of patients showing improvement in mouth opening [21]. This shows a need to carefully monitor outcomes to try to ascertain what factors favour positive outcomes so that these can be the focus of treatment plans. \ud
Médecins Sans Frontières (MSF) runs programs at the Noma Children’s Hospital (NCH) in Sokoto, northern Nigeria, and currently assists with surgical interventions for the patients who have survived and sought care at the hospital. Community outreach, active case finding, follow up assessments and prevention programming are also supported by MSF. These projects place MSF in a unique position to study Noma, and to add to the scant body of knowledge around the disease. \ud
In 2017, MSF conducted a comprehensive descriptive study of the Noma patients treated since 2015 in the project in addition to a case control study for Noma patients. Results from these studies indicated that current routine data collection was sub-optimal. In order to be able to track clinical outcomes of Noma patients, more robust data collection and longer term follow up is needed. \ud
The current study aims to address one of the highlighted gaps from the 2017 case review which is the absence of comprehensive information on surgeries performed (including techniques) and clinical outcomes of Noma patients after surgery (in terms of surgical, anaesthesia-related and post-surgical complications, including infections) and outcome information after discharge from the hospital. Additionally, it will aim to establish better ways in which to ensure that current medical data on previous medical and vaccination history of each individual Noma patient are being accurately collected and analysed. Only by implementing a systematic and controlled method of data collection in conjunction with systematic follow up will our medical teams learn from current interventions and be able to use these recommendations for improved clinical management
Case-study: A retrospective assessment of transmission of Ebola virus disease (EVD) through a rural Sierra Leonean community and the impact on mortality and health seeking behaviours.
No full textResearch ProtocolOBJECTIVES\ud
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2.1. PRIMARY OBJECTIVES\ud
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To provide a comprehensive description of mortality and transmission of EVD and the community response to EVD in one rural Sierra Leonean community in Kailahun District throughout the course of an outbreak.\ud
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2.2. SECONDARY OBJECTIVES\ud
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1. Describe the transmission and associated morbidity and mortality of EVD within the village throughout the course of the outbreak, with particular attention to the period prior to the MSF Ebola Management Centre (EMC) opening in Kailahun district (May-June 2014) and the period during which it was receiving cases from the village under study (July-November 2014).\ud
2. Estimate overall and cause-specific mortality (EVD and non-EVD) in under-5 and 5 and older populations within the study village\ud
3. Estimate the secondary cases due to Ebola in quarantined and non-quarantined households.\ud
4. Document the broader impact of the Ebola virus outbreak on health-seeking behaviours and disease outcomes in general, including changes in access to healthcare, illness beliefs and perceptions of healthcare providers.\ud
5. Determine level and factors associated with access and uptake of MSF EMC services within affected households
Effectiveness and safety of 20+ months treatment regimen for Multidrug Resistant Tuberculosis in Manzini Region, Swaziland
No full textResearch ProtocolObjectives\ud
Primary:\ud
To describe outcomes of all patients started on the national MDR-TB treatment protocol in Matsapha & Mankayane by the MSF Manzini Project, Swaziland since its inception in 2011.\ud
Secondary: \ud
To identify any difference in outcomes between HIV-co-infected and non-co-infected MDR-TB patients.\ud
To identify risk factors associated with poor outcomes (loss to follow up, treatment failure and death).\ud
To evaluate time to culture conversion.\ud
To evaluate time to poor outcomes (loss to follow up, treatment failure and death)
Maternal and child health care seeking behaviour: a household survey and interview study in an urban and rural area of Sierra Leone, 2016
No full textResearch ProtocolTo describe health seeking behaviour during pregnancy, for childbirth and in children under the age of five years, and to identify barriers to accessing and receiving healthcare services at the time of the study and since the start of the Ebola outbreak in an urban and rural area of Tonkolili District. \ud
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2.2 PRIMARY OBJECTIVES\ud
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1. To estimate utilisation of health facilities by women for childbirth in Magburaka town and Yoni chiefdom since the start of the Ebola outbreak ;\ud
2. To estimate utilisation of healthcare services by children aged <5 years in Magburaka town and Yoni chiefdom during their most recent febrile illness within the three month period preceding the day of the survey.\ud
3. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare during pregnancy and for childbirth \ud
4. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare for febrile illness in children aged <5 year