• HAART can be provided safely in African HIV positive children: analysis of patients in 2 urban health centres in Kigali (Rwanda)

      De Naeyer, L; van Griensven, J; Ubarijoro, S; Mushi, T; Ntabashwa, G; Gazille, C; Zachariah, R (2006)
    • Hand hygiene compliance and environmental contamination with gram-negative bacilli in a rural hospital in Madarounfa, Niger

      Tang, K; Berthe, F; Nackers, F; Hanson, K; Mambula, C; Langendorf, C; Marquer, C; Isanaka, S (Oxford University Press, 2019-10-14)
      Background Healthcare-associated infections pose a major, yet often preventable risk to patient safety. Poor hand hygiene among healthcare personnel and unsanitary hospital environments may contribute to this risk in low-income settings. We aimed to describe hand hygiene behaviour and environmental contamination by season in a rural, sub-Saharan African hospital setting. Methods We conducted a concurrent triangulation mixed-methods study combining three types of data at a hospital in Madarounfa, Niger. Hand hygiene observations among healthcare personnel during two seasons contributed quantitative data describing hand hygiene frequency and its variability in relation to seasonal changes in caseload. Semistructured interviews with healthcare personnel contributed qualitative data on knowledge, attitudes and barriers to hand hygiene. Biweekly environmental samples evaluated microbial contamination from October 2016 to December 2017. Triangulation identified convergences, complements and contradictions across results. Results Hand hygiene compliance, or the proportion of actions (handrubbing or handwashing) performed out of all actions required, was low (11% during non-peak and 36% during peak caseload seasons). Interviews with healthcare personnel suggesting good general knowledge of hand hygiene contradicted the low hand hygiene compliance. However, compliance by healthcare activity was convergent with poor knowledge of precise hand hygiene steps and the motivation to prevent personal acquisition of infection identified during interviews. Contamination of environmental samples with gram-negative bacilli was high (45%), with the highest rates of contamination observed during the peak caseload season. Conclusion Low hand hygiene compliance coupled with high contamination rates of hospital environments may increase the risk of hospital-acquired infections in sub-Saharan African settings.
    • Handle Survivors with Care

      Sprecher, A (Massachusetts Medical Society, 2017-10-12)
    • Having and Fighting Ebola - Public Health Lessons from a Clinician Turned Patient

      Spencer, Craig (Massachusetts Medical Society, 2015-03-19)
    • 'He who helps the guilty, shares the crime'? INGOs, moral narcissism and complicity in wrongdoing

      Buth, P; de Gryse, B; Healy, S; Hoedt, V; Newell, T; Pintaldi, G; Del Valle, H; Sheather, JC; Wong, S (BMJ Publishing Group, 2018-03-17)
      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.
    • 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)
    • Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey.

      Page, A-L; Hustache, S; Luquero, F J; Djibo, A; Manzo, M L; Grais, R; Epicentre, Paris, France. anne-laure.page@epicentre.msf.org (2011-05-25)
      Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases.
    • Health Care Workers' Perceptions of Point-of-Care Testing in a Low-Income Country-A Qualitative Study in Southwestern Uganda

      Rasti, R; Nanjebe, D; Karlström, J; Muchunguzi, C; Mwanga-Amumpaire, J; Gantelius, J; Mårtensson, A; Rivas, L; Galban, F; Reuterswärd, P; et al. (Public Library of Science, 2017-07-27)
      Point-of-care (POC) tests have become increasingly available and more widely used in recent years. They have been of particular importance to low-income settings, enabling them with clinical capacities that had previously been limited. POC testing programs hold a great potential for significant improvement in low-income health systems. However, as most POC tests are developed in high-income countries, disengagement between developers and end-users inhibit their full potential. This study explores perceptions of POC test end-users in a low-income setting, aiming to support the development of novel POC tests for low-income countries.
    • Health development versus medical relief: the illusion versus the irrelevance of sustainability.

      Ooms, G; Belgian section of Médecins Sans Frontières. ooms@brussels.msf.org (Public Library of Science, 2006-08)
    • Health in the service of state-building in fragile and conflict affected contexts: an additional challenge in the medical-humanitarian environment

      Philips, Mit; Derderian, Katharine (BioMed Central (Springer Science), 2015-03-29)
      Global health policy and development aid trends also affect humanitarian health work. Reconstruction, rehabilitation and development initiatives start increasingly earlier after crisis, unleashing tensions between development and humanitarian paradigms. Recently, development aid shows specific interest in contexts affected by conflict and fragility, with increasing expectations for health interventions to demonstrate transformative potential, including towards more resilient health systems as a contribution to state-building agendas.
    • Health leadership in sub-Saharan Africa.

      Harries, Anthony D; Schouten, Erik J; Ben-Smith, Anne; Zachariah, Rony; Phiri, Sam; Sangala, Wesley O O; Jahn, Andreas; Old Inn Cottage, Vears Lane, Colden Common, Winchester SO21 1TQ, UK adharries@theunion.org. (2009-10)
    • Health seeking and sexual behaviour in patients with sexually transmitted infections: the importance of traditional healers in Thyolo, Malawi.

      Zachariah, R; Nkhoma, W; Harries, A D; Arendt, V; Chantulo, A; Spielmann M P; Mbereko, M; Buhendwa, L; Médecins Sans Frontières, Luxembourg, Thyolo District, Malawi. msflblantyre@malawi.net (BMJ Journals, 2002-04)
      OBJECTIVES: To describe health seeking and sexual behaviour including condom use among patients presenting with sexually transmitted infections (STIs) and, to identify sociodemographic and behavioural risk factors associated with "no condom use" during the symptomatic period. METHODS: A cross sectional study of consecutive new STI cases presenting at the district STI clinic in Thyolo, Malawi. They were interviewed by STI counsellors after obtaining informed consent. All patients were treated according to national guidelines. RESULTS: Out of 498 new STI clients, 53% had taken some form of medication before coming to the STI clinic, the most frequent alternative source being the traditional healer (37%). 46% of all clients reported sex during the symptomatic period (median 14 days), the majority (74%) not using condoms. 90% of all those who had not used condoms resided in villages and had seen only the traditional healer. Significant risk factors associated with "no condom use" included visiting a traditional healer, being female, having less than 8 years of school education, and being resident in villages. Genital ulcer disease (GUD) was the most common STI in males (49%) while in females this comprised 27% of STIs. CONCLUSIONS: These findings, and especially the extremely high GUD prevalence is of particular concern, considering the high national HIV prevalence in Malawi (9%) and the implications for STI and HIV transmission. There is an urgent need to integrate traditional healers in control activities, encourage their role in promoting safer sexual behaviour, and to reorient or even change existing strategies on condom promotion and STI control.
    • Health Services for Gender-Based Violence: Médecins Sans Frontières Experience Caring for Survivors in Urban Papua New Guinea

      Lokuge, K; Verputten, M; Ajakali, M; Tolboom, B; Joshy, G; Thurber, K A; Plana, D; Howes, S; Wakon, A; Banks, E (Public Library of Science, 2016-06-10)
      Levels of gender-based violence in Papua New Guinea (PNG) are high; health services for survivors are limited. Evidence from the few existing health services for survivors can inform improvements in care in this and similar settings.
    • Health-seeking behaviour and community perceptions of childhood undernutrition and a community management of acute malnutrition (CMAM) programme in rural Bihar, India: a qualitative study.

      Burtscher, D; Burza, S (Cambridge University Press, 2015-03-10)
      Objective Since 2009, Médecins Sans Frontières has implemented a community management of acute malnutrition (CMAM) programme in rural Biraul block, Bihar State, India that has admitted over 10 000 severely malnourished children but has struggled with poor coverage and default rates. With the aim of improving programme outcomes we undertook a qualitative study to understand community perceptions of childhood undernutrition, the CMAM programme and how these affected health-seeking behaviour.
    • Hepatitis B virus in the Lao People's Democratic Republic: A Cross Sectional Serosurvey in Different Cohorts.

      Black, Antony P; Nouanthong, Phonethipsavanh; Nanthavong, Naphavan; Souvannaso, Chanthasone; Vilivong, Keooudomphone; Jutavijittum, Prapan; Samountry, Bounthome; Lütteke, Nina; Hübschen, Judith M; Goossens, Sylvie; et al. (BioMed Central (Springer Science), 2014-08-23)
      Despite hepatitis B vaccination at birth and at 6, 10 and 14 weeks of age, hepatitis B virus (HBV) infection continues to be endemic in the Lao People's Democratic Republic (PDR). We carried out a cross-sectional serological study in infants, pre-school children, school pupils and pregnant women to determine their burden of disease, risk of infection and vaccination status.
    • Hepatitis C seroprevalence and HIV co-infection in sub-Saharan Africa: a systematic review and meta-analysis

      Rao, V Bhargavi; Johari, Nur; du Cros, Philipp; Messina, Janey; Ford, Nathan; Cooke, Graham S (Elsevier, 2015-05-05)
      An estimated 150 million people worldwide are infected with hepatitis C virus (HCV). HIV co-infection accelerates the progression of HCV and represents a major public health challenge. We aimed to determine the epidemiology of HCV and the prevalence of HIV co-infection in sub-Saharan Africa.
    • Hepatitis C Virus Diagnosis and the Holy Grail

      Applegate, TL; Fajardo, E; Sacks, JA (Elsevier, 2018-06)
      The world has embraced the call for global elimination of hepatitis C virus by 2030. The unprecedented speed of therapeutic development and increased access to direct-acting antivirals has made elimination a possibility. We must screen hundreds of millions of people to diagnose and treat those currently infected. Global access to hepatitis C virus diagnostics will be a keystone to success. Key challenges must be overcome and systems optimized to ensure widespread access to existing diagnostics. Although promising technologies may soon transform the landscape, innovative strategies are needed to stimulate investment and accelerate the development of point-of-care hepatitis C virus diagnostics.
    • Hepatitis E should be considered a neglected tropical disease.

      Asman, AS; Ciglenecki, I; Wamala, JF; Lynch, J; Aggarwal, R; Rahman, M; Wong, S; Serafini, M; Moussa, AM; Dalton, HR; et al. (Public Library of Science, 2019-07-25)
    • Hepatitis E, Central African Republic.

      Escribà, J M; Nakoune, E; Recio, C; Massamba, P M; Matsika-Claquin, M D; Goumba, C; Rose, A M C; Nicand, E; García, E; Leklegban, C; et al. (2008-04)