• 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; Greig, Jane; Casas, Esther C; MSF-OCA (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.
    • The Impact of digital X-ray with Teleradiology on Case Management in Mweso, Democratic Republic of Congo

      Kosack, Cara; Halton, Jarred; Greig, Jane; Shanks, Leslie; Spijker, Saskia; MSF-OCA (2018-07)
      Study objectives 3.1 Primary objective To demonstrate the extent of change in patient management through the availability of digital X-ray with teleradiology consultation. 3.2 Secondary objectives a) To demonstrate the extent of change in patient diagnosis through the availability of digital X-ray with teleradiology consultation. b) To demonstrate the extent of change in patient diagnosis and management in the subgroup of patients with chest pathologies through the availability of digital X-ray with teleradiology consultation. c) To estimate if the extent of change in diagnosis and management is different in patients < 5 years of age versus ≥5 years of age.
    • Improving utilisation of services for sexual and gender-based violence (SGBV): knowledge, attitudes, practices and perceptions (KAP) in Jahangipuri, Delhi India protocol

      Himanshu, M; Sharmin, Sabrina; Renjhen, Prachi; Saheb, Baba; Gupta, Vinita; MSF-OCA (2018-07)
      2 Research question and objectives 2.1 Research question To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Delhi, India 2.2 Primary objective To understand how to improve utilization of SGBV services for the population in MSF catchment area Delhi, India 2.3 Specific objectives 1. To understand community knowledge related to SGBV, including its consequences, treatment and clinical services 2. To understand attitudes towards health aspects of SGBV 3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake 4. To understand which strategies/activities people consider would be effective in improving access and uptake of clinical services by survivors of SGBV
    • Innovations in research ethics governance in humanitarian settings

      Schopper, Doris; Dawson, Angus; Upshur, Ross; Ahmad, Aasim; Jesani, Amar; Ravinetto, Raffaella; Segelid, Michael J; Sheel, Sunita; Singh, Jerome (BioMed Central, 2015-02-26)
    • Knowledge, Attitudes and Practice (KAP) survey of Long-Lasting Insecticide-treated bedNets (LLITNs) in the refugee camps of Kule, Tierkidi and Nguenyyiel, in Gambela, Ethiopia, MSF-OCA catchment area.

      Doyle, Kate; Isidro Carrion Martin, Antonio; Piening, Turid; Ramirez, Angela; Fesselet, Jeff; Loonen, Jeanine; Rao, V Bhargavi; Brechard, Raphael; MSF-OCA (2018-07)
      Ethiopia is a land locked country in east Africa, known for its deep culture and history as well as its struggle with disease outbreaks, drought, malnutrition and major refugee inflex’s. According to UNDP Ethiopia is ranked at 174 in the human development index. Life expectancy at birth is 64.6 years, infant mortality rate is 41.4 (per 1,000 live births), under 5 mortality rate is 59.2 (per 1,000 live births) and deaths from Malaria are 106 (per 100, 000 people). Historically, Gambella region and Itang woreda area are places of ethnic tension between original Agnuak population, Nuers who have arrived in earlier refugee movements 20+ years back, and new Nuer refugees, and Highlanders. All incomers to the area are not refugees, and movement to/from both sides of the South Sudanese border is frequent. Tribal clashes and single incidents take place often; of late the bigger fighting has been less frequent. In Gambella region there are currently 6 camps and 5 reception centers. MSF activities are focused across 3 camps (Kule, Tierkidi and Nguenyyiel) and 1 reception center (Pamdong). While the current refuges crises has been present since early 2014, over the last 18 months more than 130,000 new arrivals have entered Ethiopia, leading to the creation of the latest camp, Nguenyyiel. As of 31st March 2018, official UNHCR data indicates a total South Sudanese population in the region to be 419,259, which now exceeds the local/host population. Key demographics include; 55% of population to be female; 64% to be under 18 years of age; 88% to be women and children. Within this total there are 3,076 unaccompanied minors (0.73%) and 23,238 are separated children (5.5%). It is assumed that also in 2018 the number of unregistered refugees will massively increase due to unwillingness for relocation to other regions creating the need for further extensions or new camps. As all people staying in Gambella camps are not registered with UNHCR, many who seek help with MSF are not officially entitled to it. ARRA health Centres in Tierkidi and Nguenyyiel refuse to treat those without ration card/registration. In case of need of further referral to Gambella hospital, MSF are forced to compromise with the treatment, as those patients are not granted a permit. Across the region, but specifically in the camps served by MSF, we see very high case load of malaria, with major spikes during the rainy season. In 2017, across Kule and Tierkidi camps, MSF treated more than 70,000 people for malaria. Prevention efforts in the camps have been very weak, with limited bed net distribution (last one in 2014) and poorly planned/executed IRS campaigns (Oct 2017—late rain season). MSF will now engage to take on a more active role in prevention and treatment mechanisms including mass bed net distribution, IRS campaigns, use of primaquine (decreased transmission); improved follow up of cases requiring re-treatment as well as participating in a study with the Ethiopian Public health institute looking into the presence of HRP2 gene deletion. PRIMARY OBJECTIVES  To estimate the Long-Lasting Insecticide-Treated bedNets (LLITN) coverage ratio for the total population in the MSF catchment area SECONDARY OBJECTIVES  To describe the population surveyed by sex and age  To measure the LLITN coverage ratio for children under five years of age and pregnant women  To estimate indoor residual spraying (IRS) coverage ratio for the total population in the MSF catchment area  To assess malaria knowledge, attitude and practices in the population including recognition of symptoms, and how to prevent malaria with special focus on LLITN.  To assess knowledge, attitude and practices about malaria treatment.
    • Long term follow up of Noma patients after surgical, nutritional and mental health interventions at the Noma Children’s Hospital in northwest Nigeria, 2018

      Farley, Elise Principal Investigator; MSF OCA (2018-06-13)
      Background Noma 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. 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]. 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. 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. 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. 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.