• Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

      Huerga, H; Vasset, B; Prados, E; Médecins Sans Frontières-France, Kenya Programme, Paris, France; Clinica de Medicina Forense, Segovia, Spain (2009-02-24)
      The aim of this study was to describe and analyse hospital mortality patterns after the Liberian war. Data were collected retrospectively from January to July 2005 in a referral hospital in Monrovia, Liberia. The overall fatality rate was 17.2% (438/2543) of medical admissions. One-third of deaths occurred in the first 24h. The adult fatality rate was 23.3% (241/1034). Non-infectious diseases accounted for 56% of the adult deaths. The main causes of death were meningitis (16%), stroke (14%) and heart failure (10%). Associated fatality rates were 48%, 54% and 31% respectively. The paediatric fatality rate was 13.1% (197/1509). Infectious diseases caused 66% of paediatric deaths. In infants <1 month old, the fatality rate was 18% and main causes of death were neonatal sepsis (47%), respiratory distress (24%) and prematurity (18%). The main causes of death in infants > or =1 month old were respiratory infections (27%), malaria (23%) and severe malnutrition (16%). Associated fatality rates were 12%, 10% and 19%. Fatality rates were similar to those found in other sub-Saharan countries without a previous conflict. Early deaths could decrease through recognition and early referral of severe cases from health centres to the hospital and through assessment and priority treatment of these patients at arrival.
    • Afghanistan--humanitarian aid and military intervention don't mix.

      Ford, N (Royal College of General Practice, 2001-11)
    • Aid and safety for Guinea's refugees.

      Rostrup, M; Ford, N; Médecins Sans Frontières, London, UK. (Elsevier, 2001-04-07)
    • Angola's suffering behind a pretence of normality.

      Stokes, C; Ford, N; Sanchez, O; Perrin, J M; Poncin, M; Joly, M; Médecins Sans Frontières, London, UK. (Elsevier, 2000-12-16)
    • Barriers to prompt and effective treatment of malaria in northern Sri Lanka.

      Reilley, B; Abeyasinghe, R; Pakianathar, M V; Medecins sans Frontieres, Colombo, Sri Lanka. (Wiley-Blackwell, 2002-09)
      BACKGROUND: For the past 18 years, northern Sri Lanka has been affected by armed ethnic conflict. This has had a heavy impact on displacement of civilians, health delivery services, number of health professionals in the area and infrastructure. The north of Sri Lanka has a severe malaria burden, with less than 5% of the national population suffering 34% of reported cases. Health care providers investigated treatment-seeking behaviour and levels of treatment failure believed to be the result of lack of adherence to treatment. METHODS: Pre- and post-treatment interviews with patients seeking treatment in the outpatient department (OPD) and focus groups. RESULTS: A total of 271 persons completed interviews: 54.4% sought treatment within 2 days of the onset of symptoms, and 91.9% self-treated with drugs with prior to seeking treatment, mainly with paracetamol. Self-treatment was associated with delaying treatment (RR 3.55, CI 1.23-10.24, P=0.002). In post-treatment interviews, self-reported default was 26.1%. The main reasons for not taking the entire regimen were side-effects (57.6%) and disappearance of symptoms (16.7%). Focus groups indicated some lack of confidence in chloroquine treatment and prophylaxis, and scant enthusiasm for prevention methods. CONCLUSIONS: A number of factors contribute to a lack of access and a lower quality of care for malaria: lack of medical staff and facilities because of the fighting; lack of confidence in treatment, and perception of malaria as a routine illness. Prevention efforts need to take into account certain beliefs and practices to be successful.
    • Between War and Peace: Humanitarian Assistance in Violent Urban Settings

      Lucchi, E; Médecins Sans Frontières, Spain (2010-06-07)
      Cities are fast becoming new territories of violence. The humanitarian consequences of many criminally violent urban settings are comparable to those of more traditional wars, yet despite the intensity of the needs, humanitarian aid to such settings is limited. The way in which humanitarian needs are typically defined, fails to address the problems of these contexts, the suffering they produce and the populations affected. Distinctions between formal armed conflicts, regulated by international humanitarian law, and other violent settings, as well as those between emergency and developmental assistance, can lead to the neglect of populations in distress. It can take a lot of time and effort to access vulnerable communities and implement programmes in urban settings, but experience shows that it is possible to provide humanitarian assistance with a significant focus on the direct and indirect health consequences of violence outside a traditional conflict setting. This paper considers the situation of Port-au-Prince (Haiti), Rio de Janeiro (Brazil) and Guatemala City (Guatemala).
    • Burundi: a population deprived of basic health care.

      Philips, M; Ooms, G; Hargreaves, S; Durrant, A (Royal College of General Practitioners, 2004-08)
    • Caught in Colombia's crossfire.

      Reilley, B; Morote, S; Médecins sans Frontières, New York, USA. (The Massachusetts Medical Society, 2004-12-16)
    • Chaos in Afghanistan: famine, aid, and bombs.

      Ford, N; Davis, A; Médecins Sans Frontières, 124-32 Clerkenwell Road, EC1R 5DJ, London, UK. Nathan_FORD@msf.org (Elsevier, 2001-11-03)
    • Civilian Landmine Injuries in Sri Lanka.

      Meade, P; Mirocha, J; Medecins Sans Frontieres/Doctors Without Borders, Department of Surgery, King Drew Medical Center, Los Angeles, California 90059, USA. (2000-04)
      OBJECTIVES: The purpose of this study was to describe the injuries sustained by displaced people returning home after a military conflict when landmines were not removed. METHOD: This study describes the landmine injuries to patients at the Jaffna Teaching Hospital in northern Sri Lanka over a 20-month period, from May 1, 1996, to December 31, 1997. RESULTS: There were definite and identifiable landmine injury patterns. Patients were most often wounded in the lower extremities, had multiple wounds, and were injured together in groups. Victims were most often male, but there were unusually high numbers of women, children, and elderly injured. Mortality rates and amputation rates were high. Deaths occurred early after injury. Higher incidences of mine injuries could be associated with two important activities: returning home and agriculture. CONCLUSIONS: Civilians returning home after armed conflicts are at risk of injury when landmines are not removed. No one is spared. This problem is preventable.
    • Conflict in Sri Lanka. Sri Lanka's Health Service is a Casualty of 20 Years of War.

      Reilley, B; Simpson, I; Ford, N; DuBois, M; Médecins Sans Frontières, Colombo, Sri Lanka. (Published by: BMJ Publishing Group Ltd, 2002-02-09)
    • Consequences of armed conflict for an ethnic Karen population.

      Checchi, F; Elder, G; Schäfer, M; Drouhin, E; Legros, D; Epicentre, 8 rue Saint Sabin, 75011, Paris, France. fchecchi@epicentre.msf.org (Elsevier, 2003-07-05)
    • Effectiveness of a health education intervention in a war environment.

      Blair, A; Shiels, C; Médecins Sans Frontières, London, UK. alistair.blair@virgin.net (2002-04)
    • The efficacy of a mental health program in Bosnia-Herzegovina: impact on coping and general health.

      Mooren, T T M; de Jong, K; Kleber, R J; Ruvic, J; De Vonk, Centrum '45, Noordwijkerhout, The Netherlands. T.Mooren@Centrum45.nl (Wiley-Blackwell, 2003-01)
      The efficacy of a community-based psychosocial program in Bosnia-Herzegovina during the war and immediate postwar years (1994-1999) was described in this article. Ten centers provided various kinds of psychological help in the besieged city of Sarajevo and the towns of Zenica, Travnik, and Vitez. Since 1994, an intensive monitoring system has documented data on clients, interventions, and outcomes. This study focused on the systematic evaluation of counseling interventions aimed to alleviate the distress in wartime. The sample consisted of 3,283 and 1,785 inhabitants of Sarajevo, Zenica, Travnik, and Vitez who filled out the GHQ-28 and IES respectively. Pre- and post-assessments were compared throughout consecutive years (1994-1999) and across age groups and both sexes. Outcomes of these scales reflected very high scores, especially among people between 30 and 40 years of age. Furthermore, intake scores increased in time rather than decreased. Differences between pre- and postmeasurements are highly significant--throughout the years. Analyses revealed substantial proportions of clinically recovered or generally improved individual functioning, although some clients revealed no improvement.
    • Emergency conflict-related psychosocial interventions in Sierra Leone and Uganda: lessons from Médecins Sans Frontières

      de Jong, K; Kleber, R J; Médecins Sans Frontières, Amsterdam, The Netherlands. Kaz.de.Jong@amsterdam.msf.org (2007-05)
      Médecins Sans Frontières has been involved in emergency mental health or psychosocial programmes since 1990. In this article the intervention model developed for emergency settings is shared. Psychosocial programmes distinguish two elements. The 'psycho'-component facilitates the reconnection of the affected individual to his environment. The 'socio'-element aims to create an environment that facilitates the individual to re-integrate. The nature of mental health and psychosocial programmes requires a multidisciplinary approach. Emotional support can also be provided by regular medical staff and does not always require a specialist. The years ahead of us are important for the development of psychosocial interventions. Fundamental issues such as programme evaluation need systematic research.
    • The epidemic of visceral leishmaniasis in western Upper Nile, southern Sudan: course and impact from 1984 to 1994.

      Seaman, J; Mercer, A; Sondorp, H; MSF (Médecins sans Frontières)-Holland, Amsterdam, The Netherlands. (Oxford University Press, 1996-08)
      BACKGROUND: Although endemic in parts of southern Sudan, visceral leishmaniasis (VL) had not been reported in Western Upper Nile (WUN) until an epidemic was confirmed in 1989. A combination of circumstances created conditions for transmission among a population of mainly Nuer and Dinka people who had no immunity. The civil war which restarted in 1983 has been a major contributing cause and continues to hinder provision of treatment, data collection and control measures. METHODS: Since the first of three clinics to treat VL was established in WUN in 1989, data on the epidemic and mortality have been collected in seven retrospective surveys of villages and among patients. Adults were interviewed about surviving family members and those who had died since the epidemic came. Survey death rates are used here to estimate mortality from VL and 'excess mortality' above expected levels. RESULTS: The surveys found high mortality at all ages and suggest an overall death rate of 38-57% since the epidemic started in 1984, and up to 70% in the most affected areas. Both methods of estimation suggest that around 100,000 deaths, among about 280,000 people in the epidemic area, might be attributable to VL. CONCLUSIONS: This continuing epidemic has shown that VL can cause high mortality in an outbreak with astonishingly high infection rates. Population movement has been a major factor in transmission and poor nutritional status has probably contributed to the risk of clinical infection. Although over 17,000 people have been successfully treated for VL at the clinics in WUN, the disease is likely to become endemic there.
    • Epidemic Visceral Leishmaniasis in Southern Sudan: Treatment of Severely Debilitated Patients Under Wartime Conditions and with Limited Resources.

      Seaman, J; Mercer, A; Sondorp, H; Herwaldt, B L; Médecins sans Frontières-Holland, Amsterdam, The Netherlands. (1996-04-01)
      OBJECTIVES: 1) To determine the proportions of patients with visceral leishmaniasis who had various treatment outcomes when cared for under wartime conditions and with limited resources and 2) to identify patient characteristics associated with the outcomes. DESIGN: Cohort study. SETTING: Médecins sans Frontières-Holland's treatment center in Duar, Western Upper Nile Province, an area in southern Sudan that has been severely affected by Sudan's civil war and a massive epidemic of visceral leishmaniasis. PATIENTS: 3076 consecutive patients who had visceral leishmaniasis, were admitted to the treatment center the first year the center was operational (August 1990 to July 1991), and were treated with the pentavalent antimonial compound sodium stibogluconate. MEASUREMENTS: Patient characteristics on admission and four mutually exclusive treatment outcomes (default during first admission, death during first admission, discharge and readmission for retreatment [relapse], and discharge and no readmission for retreatment [successful treatment]). RESULTS: The patients had a median age of 15 years and were notably anemic (median hemoglobin level, 77g/L) and malnourished (median body mass index of adults [> or = 18 years of age], 15.2 kg/m2); most (91.0%) had been sick less than 5 months. Although patients could not be monitored after treatment to document cure, most (2562 [83.3%]) were successfully treated; 336 (10.9%) died during their first admission, and 79 are known to have relapsed (3.0% of those discharged alive [that is, those whose final treatment outcome was successful treatment or relapse]). In univariable analysis, young and older age (<5 or > or = 45 years of age), long duration of illness (> or = 5 months), markedly low hemoglobin level or body mass index, large spleen, high parasite density, and vomiting at least once during the treatment course were associated with death. In multiple logistic regression analysis of data for a subgroup of 1207 adults (those who did not default or relapse and for whom data were recorded on age, sex, duration of illness, hemoglobin level, body mass index, and spleen size), the approximate risk ratios for death were 2.2 (95% Cl, 1.4 to 3.6) for those with a long duration of illness, 3.6 (Cl, 2.1 to 5.9) for those 45 years of age or older, 4.6 (Cl, 2.2 to 9.4) for those with a hemoglobin level less than 60 g/L, and 12.2 (Cl, 3.2 to 47.2) for those with a body mass index less than 12.2 kg/m2. CONCLUSION; Despite the severe debility of the patients and the exceptionally difficult circumstances under which they were treated, most fared remarkably well.
    • Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo

      Hustache, S; Moro, M R; Roptin, J; Souza, R; Gansou, G M; Mbemba, A; Roederer, T; Grais, R; Gaboulaud, V; Baubet, T; et al. (2009-04-01)
      ABSTRACT: BACKGROUND: Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo. METHODS: Women who attended the Médecins Sans Frontières program for sexual violence in Brazzaville during the conflict were selected to evaluate the psychological consequences of rape and the late effect of post-rape psychological support. A total of 178 patients met the eligibility criteria: 1) Women aged more than 15 years; 2) raped by unknown person(s) wearing military clothes; 3) admitted to the program between the 1/1/2002 and the 30/4/2003; and 4) living in Brazzaville. RESULTS: The initial diagnosis according to DSM criteria showed a predominance of anxious disorders (54.1%) and acute stress disorders (24.6%). One to two years after the initial psychological care, 64 women were evaluated using the Trauma Screening Questionnaire (TSQ), the Global Assessment of Functioning scale (GAF) and an assessment scale to address medico-psychological care in emergencies (EUMP). Two patients (3.1%) met the needed criteria for PTSD diagnosis from the TSQ. Among the 56 women evaluated using GAF both as pre and post-test, global functioning was significantly improved by initial post-rape support (50 women (89.3%) had extreme or medium impairment at first post-rape evaluation, and 16 (28.6%) after psychological care; p = 0.04). When interviewed one to two years later, the benefit was fully maintained (16 women (28.6%) presenting extreme or medium impairment). CONCLUSION: We found the benefits of post-rape psychological support to be present and lasting in this conflict situation. However, we were unable to evaluate all women for the long-term impact, underscoring the difficulty of leading evaluation studies in unstable contexts. Future research is needed to validate these findings in other settings.
    • Field research in humanitarian medical programmes. Treatment of a cohort of tuberculosis patients using the Manyatta regimen in a conflict zone in South Sudan.

      Keus, K; Houston, S; Melaku, Y; Burling, S; Médecins Sans Frontières-Holland, Max Euweplein 40, PO Box 10014, 1001 EA Amsterdam, The Netherlands. (Elsevier, 2008-01-31)
      This is a descriptive report of a pilot project of tuberculosis (TB) treatment in a conflict zone. A TB programme was implemented by Médecins Sans Frontières(MSF)-Holland in a semi-nomadic population in a very insecure and underdeveloped area of Upper Nile province in Southern Sudan. Outcome measures were operational feasibility, default rate, and sputum smear conversion at 4 months. A cohort of TB patients was admitted over a 10-week period (July-September 2001). Adherence strategy, project implementation, and and contingency planning were adapted to local conditions. The treatment regimen (4 HRZE [4-month daily supervised regimen] followed by 3EH or 3TH [3-month unsupervised regimen]: isoniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) and thiacetazone (T)) was a variant on the Manyatta regimen developed for semi-nomads in Kenya. Of 163 patients, 84 (52%) were children aged < 15 years. Lymph node TB comprised 34% and spinal TB 15% of all patients. Among adults, 41% had smear-positive pulmonary disease. Only 1 patient (0.6%) defaulted. All sputum smear-positive patients who completed 4 months of therapy converted to smear-negative, although 2 were subsequently found to have relapsed. TB in complex emergency situations is an underrecognized priority. Using an approach adapted especially to this setting, TB treatment was successfully implemented with minimal risk of promoting drug resistance, in an unstable setting.
    • Health and war in Congo-Brazzaville.

      Salignon, P; Cabrol, J C; Liu, J; Legros, D; Brown, V; Ford, N; Médecins Sans Frontières and Epicentre, Paris, France. (Elsevier, 2000-11-18)