• 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.

      Duncombe, Jennifer; Caleo, Grazia; Mills, Clair; Passmore, Charlotte; Kremer, Ronald; Lokuge, Kamalini; Greig, Jane; Lamin, Manjo; MSF-OCA (2018-07)
      OBJECTIVES 2.1. PRIMARY OBJECTIVES  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. 2.2. SECONDARY OBJECTIVES 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). 2. Estimate overall and cause-specific mortality (EVD and non-EVD) in under-5 and 5 and older populations within the study village 3. Estimate the secondary cases due to Ebola in quarantined and non-quarantined households. 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. 5. Determine level and factors associated with access and uptake of MSF EMC services within affected households.
    • Declaration of End of Study

      MSF ERB (2016-11-07)
    • Determination of the most accurate diagnostic approach for the diagnosis of human brucellosis in Lankien, South-Sudan

      Kosack, Cara; Page, Anne-Laure; Moriyon, Ignacio; Zuniga, Amaia; Conde, Raquel; Laku, Richard; MSF-OCA (2018-07)
      3. Objectives 3.1 Primary objective To estimate the diagnostic accuracy (sensitivity, specificity, positive and negative predicative values and likelihood ratios) of the modified RBT method and the rapid diagnostic test developed by the KIT tests performed (if commercially available) at Institute for Tropical Health (ITH), the University of Navarra, Pamplona, Spain for the diagnosis of brucellosis. Specimens collected in an endemic region (South Sudan) will be used and characterized at the ITH at the University of Navarra, Pamplona, Spain with undiluted RBT, SAT, Coombs test, Brucellacapt and when necessary an indirect ELISA used as the reference tests. 3.2 Secondary objectives • To assess the diagnostic accuracy (sensitivity, specificity, positive and negative predicative values and likelihood ratios) of the Rose Bengal test (Spinreact, Spain) at the study site. • To assess inter-user agreement of the RB test performed on site and at ITH. • To optimize the buffer used in the RBT using characterized sera available at ITH and evaluate the diagnostic performance of the modified method with serum dilution using specimens collected in this study. To date the buffer conditions are those used for diagnosis in cattle and they have not been optimized for diagnosis in humans. In fact, the conditions used in the Brucellacapt (i.e. a special buffer at pH 5.0) also render all antibodies agglutinating. Therefore, some simple modifications of the RBT conditions (i.e. pH and ionic strength) may improve the performance of RBT and produce a similarly simple but better test. • To estimate the diagnostic performance of an ‘in-house’ latex-agglutination test against Brucella-specific cytosoluble proteins. • To describe the clinical characteristics of brucellosis suspects and confirmed cases • To assess/identify risk factors for brucellosis in the study population
    • Determining sero-prevalence of antibodies against Hepatitis E during an acute outbreak scenario.

      Lenglet, Annick; Kamau, Charity; Boris, Hogema; MSF-OCA (2018-07)
      OBJECTIVES 3.1 PRIMARY OBJECTIVES To estimate sero prevalence of anti-HEV antibodies (IgG and IgM) in different age groups in Am Timam, Chad 3.2 SECONDARY OBJECTIVES • To determine individual risk factors associated with different anti-HEV antibody status during an acute outbreak; • To determine household level risk factors associated with different anti-HEV antibody status during an acute outbreak; • To compare the sero prevalence of anti-HEV antibodies (IgG and IgM) in different age groups at two different time periods during an acute HEV outbreak to inform our understanding of viral transmission dynamics in a population in this context; • To determine sero prevalence in different age groups of other jaundice causing agents (malaria, hepatitis A, B and C, leptospirosis and arboviral diseases such as yellow fever, viral haemorrhagic fever, Dengue and Rift valley fever; • To compare dried blood spots (DBS) with blood samples for detection of HEV IgM and IgG and HEV RNA through PCR; • To compare oral swabs with blood samples for the detection of HEV IgM and IgG and HEV RNA through PCR.
    • Effectiveness and safety of 20+ months treatment regimen for Multidrug Resistant Tuberculosis in Manzini Region, Swaziland

      Verdecchia, Maria; MSF-OCA (2018-07)
      Objectives Primary:  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. Secondary:  To identify any difference in outcomes between HIV-co-infected and non-co-infected MDR-TB patients.  To identify risk factors associated with poor outcomes (loss to follow up, treatment failure and death).  To evaluate time to culture conversion.  To evaluate time to poor outcomes (loss to follow up, treatment failure and death).
    • Evaluating the effectiveness and burden of diabetes care in a complex humanitarian emergency setting in Mweso, North Kivu, Democratic Republic of the Congo (DRC), 2015

      Caleo, Grazia; Ngadjo, Cyril; Roberts, Bayard; Kitembo, Augustin Wika; Jobanputra, Kiran; Perel, Pablo; de la Croix, Jean; Sadique, Zia; de Wit, Marit; MSF-OCA (2018-07)
      Executive summary Background: Since 2008 Médecins Sans Frontières-Operational Centre Amsterdam (MSF-OCA) has been working in Mweso health zone, North Kivu, Democratic Republic of the Congo (DRC). In collaboration with the local Ministry of Health (MoH), MSF-OCA supports the Hospital in Mweso and 4 out of 23 Primary Health Care clinics. Mweso Hospital routinely treats diabetic patients presenting with acute complications and in need of treatment (insulin and/or oral treatment). Since 2011, this has been extended to the out-patient clinic, but without clinical guidance or standard operating procedures (SOP), nor specifically trained staff. The Mweso project reports increasing numbers of patients with diabetes and diabetes-related complications, and requested from MSF-OCA to implement a formal diabetes service to improve quality of care for Diabetics. Rationale: A new model of diabetes care was implemented by MSF-OCA in Mweso in March 2015. The model (Integrated Diabetic Clinic within an Outpatient Department (IDC-OPD)) is based on simplified context-adapted clinical guidelines, clinical SOPs, adapted patient counselling & support materials, medications from World Health Organization(WHO) Essential Medicines list, and one-off staff training by a Diabetologist. This represents an opportunity to evaluate and refine this model of diabetes care to support its application in comparable settings. Furthermore there is an opportunity to benchmark diabetes burden in the MSF Catchment area and measure its diabetes care coverage in the area. Overall aim: To evaluate IDC-OPD in Mweso health zone, North Kivu, DRC. The specific objectives are to examine: • The reach (coverage) of the diabetes service to the intended target population. • The effectiveness of IDC-OPD in improving diabetes outcomes (fasting blood glucose and complications) • Adoption / acceptance of IDC-OPD by staff and patients • Implementation of IDC-OPD in terms of consistency/fidelity, adaptation and costs • Maintenance of IDC-OPD in patients and programme over time.
    • Evaluating the input of the nurse to quality of medical/or healthcare in humanitarian settings

      Gilday, Josie; Chatler, Tracey; Treacy-Wong, Vicky; Stringer, Beverley; MSF-OCA (2018-07)
      Key objective • Develop a basic framework to evaluate quality nursing care in humanitarian settings.
    • Evaluation of Second Line Antiretroviral Treatment Outcomes and Determinants in Epworth, MSF-OCA HIV Cohort, Zimbabwe

      Zizhou, Simukai; Gashu, Tadele; Ahmad, Bilal; Dhliwayo, Rumbidzai; Aluma, Theresa; Gonzalez, Lucia; Sang, Sibylle; Mesic, Anita; Otiato, Alice Ayuma; Belaye, Abi Kebra; et al. (2018-07)
      Summary Epworth poly-clinic is found in Epworth district, Harare. It is a clinic jointly run by Epworth local board (on behalf of the Ministry of Health and Child Care) and Médecins sans Frontiers (MSF). One of the major MSF activities in the clinic is early detection and management of patients who fail first line ART. Patients with elevated viral load (VL), HIV RNA greater than 1000 copies/ml, undergo five to six sessions of two weekly enhanced adherence counseling (EAC) support. After enhanced adherence counseling sessions, those with elevated repeat VL test result are then switched to second line ART. Since the number of patients on second line ART is growing, there is an increased need to know the outcomes of second line ART and predictors of treatment failure. The main objective of this study is to evaluate the prognosis and determinants of second line ART regimen for cohort of HIV patients in Epworth MoH/MSF poly-clinic, Zimbabwe. The study will also identify cumulative incidence of SL ART treatment failure through clinical, immunological or virological criteria at 6, 12, 24 and 36 months of second line ART initiation for a cohort of patients enrolled from March 2009 to January 2016 in Epworth poly-clinic. This is a retrospective cohort study of patients on second line ART in Epworth poly-clinic enrolled since 2009. We describe baseline characteristics and outcomes of treatment using descriptive analysis. Multivariate cox proportional hazard modeling is used to model predictors of time to treatment failure. Kaplan–Meier curve is used to calculate cumulative incidence of treatment failure at 6, 12, 24 and 36 months of second line ART initiation. The study is expected to be finished and communicated to relevant stakeholders in December 2016. The report will be published on peer reviewed journals in January 2017. All the costs needed for this study will be covered by MSF OCA.
    • Exploring the experiences of returned Ebola Virus Disease workers from the United Kingdom

      Cooper, Jane; Falade, Bankole; Mannell, Jenevieve; MSF-OCA (2018-07)
      A brief summary of MSF EVD programmes & workers MSF has been running EVD programmes including Treatment Centres in affected countries since early 2014, and currently employs 325 international and around 4150 national staff . MSF protocols to deliver care and control transmission, and to ensure and monitor the health of workers, were available, based on experience in previous outbreaks over many years. In the latter part of 2014, other organisations and national governments established programmes in, and/or sent volunteer workers to, affected countries. In parallel, national protocols for the monitoring of returned workers, and the screening of travellers, have been established in many countries. MSF international workers have, to date, numbered some [insert] in total. Infection of MSF workers has been relatively rare, being reported in [insert] international workers, and [insert] national workers; [insert] of the latter have died. Most cases in national workers have been attributed to exposures in the community. No cases of infection due to secondary transmission from infected MSF international workers have been identified. [check]. To date, [insert] MSF international workers have returned to the UK; [insert] of these have undertaken more than one mission. No UK returnees have been infected [check] Overall aim: To describe and explore the experiences of UK EVD workers during the period following their return Specific objectives: 1. To explore experiences, perceptions, and views of interactions with family and friends 2. To explore experiences, perceptions, and views of interactions with the general public 3. To explore experiences, perceptions, and views of interactions with colleagues and managers in returning to work 4. To explore experiences, perceptions, and views of public opinion and media coverage 5. To explore experiences, perceptions, and views of policy implementation 6. To identify potential lessons, and areas for potential future research, relevant to the management of staff and programmes
    • Field evaluation of the performance of HCV Serological Rapid Diagnostic Tests among HCV/HIV co-infected patients

      Gupta, Ekta; Carnimeo, Valentina; Samukcham, Inao; Loarec, Anne; Mahajan, Supriya; Choudhary, Manish; Bastard, Mathieu; Maman, David; Page, Anne Laure; MSF-OCA (2018-07)
      P R O T O C O L S U M M A R Y  Title: Field evaluation of the performance of HCV Serological Rapid Diagnostic Tests among HCV/HIV co-infected patients.  Aim: To evaluate the performance of serological HCV Rapid Diagnostic Tests (RDTs) to identify tests adapted to resource-limited settings, reliable for HIV-infected patients.  Study design: Prospective evaluation of the performance of serological RDTs for HCV screening.  Primary objective: o To evaluate the performance of serological HCV RDTs under field conditions using as reference standard a combination of enzyme immunoassay (EIA) and recombinant immunoblot assay (RIBA) for the detection of antibodies anti-HCV in HIV infected patients.  Secondary objectives: o To describe the accuracy (sensitivity, specificity) of the RDTs as screening tests o To describe the performance of the RDTs according to the HCV genotype and HCV VL o To describe the performance of the RDTs according to the CD4 counts and HIV VL o To describe the performance of the RDTs in presence of HBV co-infection (presence of antigen anti-HBs (HBsAg)) o To describe the operational characteristics of the tests including ease of use, technical complexity and inter-reader variability. o To evaluate predictive values of each HCV RDT based on the prevalence of the testing center.
    • Field Research Survey

      MSF USA; LuxOR; MSF (2018-07-12)
    • A Guide to Using Qualitative Research Methodology

      Nouria Bricki, Judith Green; MSF OCA and Senior Lecturer in Sociology, Health Services Research Unit, London School of Hygiene and Tropical Medicine (2007-02)
      A guide to using qualitative research methodology developed by OCA and an external academic
    • Health and developmental outcomes of low-birth-weight infants born at the Centre de Référence d’Urgences Obstétricales (CRUO), Port-au-Prince, Haiti.

      Hillaire, Marjorie; Lenglet, Annick; Ariti, Cono; Ledger, Elizabeth; Reilly, Liam; Berthet, Marine; Faniyan, Olu; MSF-OCA (2018-07)
      Summary Title A prospective cohort study investigating health and developmental outcomes of low birth weight infants born at the Centre de Reference d’Urgences Obstretricales (CRUO), Port-au-Prince, Haiti. Primary objective: To describe and compare health and developmental outcomes between low birthweight (LBW) and normal weight infants up to 24 months post-partum, corrected for gestational age. Secondary objective To identify risk factors associated with negative health and developmental outcomes in LBW infants.
    • Health Seeking Behaviour in Kamrangirchar

      Jeroen van der Heijden; OCA (2018-09-28)
    • Health Service Access Survey among Non-camp Syrian Refugees in Irbid Governorate, Jordan

      Rehr, Manuela; Shoaib, Muhammad; Deprade, Anais; Lenglet, Annick; Ait-Bouziad, Idriss; Altarawneh, Mohammad; Alshafee, Abdel Razzaq; Gabashneh, Sadeq; MSF-OCA (2018-07)
      2. OBJECTIVES 2.1. PRIMARY OBJECTIVES • To determine the level of access to health care services for Syrian refugees living out-of-camp in Irbid governorate, Jordan. 2.2. SECONDARY OBJECTIVES • To describe the socio-demographic characteristics of the surveyed population including age, gender, disabilities, time living in Jordan, living conditions, and legal status • To describe the economic situation of the surveyed households with regards to income & income sources, dependency on humanitarian assistance, household expenditures and direct and indirect expenditures on health • To characterize health care utilization of non-camp Syrian refugees including frequency & type of services used as well as the main reasons for requiring medical care • To estimate coverage with the most crucial health services such as vaccination coverage of under 5-year-old children, coverage with services for non-communicable diseases and maternal health coverage. • To estimate the coverage of MSF services including specifically NCD care as well as ANC and child health care • To estimate health service needs by estimating the household- prevalence of NCDs as well as the birth rate. • To identify barriers to accessing general-, as well as specialized health care services with regards to economic constraints, barriers resulting from knowledge gaps as well as limitations in accessibility and/or acceptability of existing services. • To identify risk factors for not accessing general and specialized health services as needed. • To estimate retrospectively the crude mortality rate (CMR) and specific mortality rates for the total population and for children under five years of age (U5MR).
    • The Impact of a Tick-Sheet in Improving Interpretation Accuracy of Chest Radiographs by Non-Specialists in an HIV positive cohort

      Kosack, Cara; Mesic, Anita; Spijker, Saskia; Bonnet, Maryline; Joekes, Elizabeth; MSF-OCA (2018-07)
      Study objective 3.1 Primary objective To determine if the application of a tick-sheet after four hour training on its use and on CXR interpretation, improves the interpretation accuracy of CXRs for active TB, by nonspecialists, in an HIV-positive cohort. 3.2 Secondary objective To determine whether the application of a tick-sheet reduces the inter-reader variability of CXR interpretation in a group of non-specialists by comparing the inter-reader agreement before and after intervention.