• Research Protocol - Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009

      Fernandez, M; Schomaker, Michael; Mason, Peter R; Fesselet, Jean François; Baudot, Yves; Boulle, Andrew; Maes, Peter; Centre of Infectious Disease Epidemiology and Research (CIDER), University of Cape Town; Biomedical Research & Training Institute and the University of Zimbabwe College of Health Sciences; MSF Amsterdam; NADAR sprl, Geographic Information Systems; MSF Brussels (2012-06-18)
      Background In highly populated African urban areas where access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions. This study aims to analyze the association between topographic elevation and the distribution of cholera cases in Harare during the cholera epidemic in 2008 and 2009. Methods We developed an ecological study using secondary data. First, we described attack rates by suburb and then calculated rate ratios using whole Harare as reference. We illustrated the average elevation and cholera cases by suburbs using geographical information. Finally, we estimated a generalized linear mixed model (under the assumption of a Poisson distribution) with an Empirical Bayesian approach to model the relation between the risk of cholera and the elevation in meters in Harare. We used a random intercept to allow for spatial correlation of neighboring suburbs. Results This study identifies a spatial pattern of the distribution of cholera cases in the Harare epidemic, characterized by a lower cholera risk in the highest elevation suburbs of Harare. The generalized linear mixed model showed that for each 100 meters of increase in the topographical elevation, the cholera risk was 30% lower with a rate ratio of 0.70 (95% confidence interval=0.66-0.76). Sensitivity analysis confirmed the risk reduction with an overall estimate of the rate ratio between 20% and 40%. Conclusion This study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Furthermore, elevation information, among other risk factors, could help to spatially orientate cholera control interventions during an epidemic.
    • Research Protocol - 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; Preito, DAvid; SAdique, Zia; de Wit, Marit; MSF UK, London; Ministry of Health, Mweso, DRC; LSHTM, London; MSF OCA, DRC; LSHTM, London; MSF OCA, DRC; MSF OCA, DRC; LSHTM, London; LSHTM, London; MSF OCA, Amsterdam (2015-08-03)
      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
    • Research Protocol - Evaluation of the Nova StatSensor Xpress Creatinine Point-Of-Care Handheld Analyzer

      Kosack, Cara Simone; de Kieviet, Wim; Bayrak, Kubra; Milovic, Anastacija; Page, Anne Laure; MSF Amsterdam; Department of Clinical Chemistry, Sint Lucas Andreas Ziekenhuis, Amsterdam, Netherlands; Epicentre, Paris, France (2015-04-17)
      To evaluate the precision and accuracy of the Nova StatSensor® XpressTM Creatinine when compared to the reference method (Ortho Vitros)) at Sint Lucas Andreas Ziekenhuis (SLAZ), Amsterdam, the Netherlands.
    • Research Protocol - Exploring Menstrual Hygiene Management (MHM) Systems, Practices and Perceptions in Selected MSF Health Structures: A Mixed Method Study

      Scott Moncrieff, Izzy; Fesselet, Jeff; Stringer, Beverley; Lenglet, Annick; MSF OCA (2019-05)
      To establish the degree to which sanitation and hygiene facilities at MSF heath structures meet the requirements of menstruating women.
    • Research Protocol - Factors Related to Fetal Death in Pregnant Women with Cholera, Haiti, 2011–2014

      Schillberg, E; Ariti, Cono; Bryson, L; Delva-Senat, R; Price, D; GrandPierre, R; Lenglet, A; MSF Haiti; London School of Hygiene and Tropical Medicine, London, UK; MSF Amsterdam; Ministère de la Santé Publique et de la Population, Port-au-Prince (2017-01-13)
      We assessed risk factors for fetal death during cholera infection and effect of treatment changes on these deaths. Third trimester gestation, younger maternal age, severe dehydration, and vomiting were risk factors. Changes in treatment had limited effects on fetal death, highlighting the need for prevention and evidence-based treatment.
    • Research Protocol - Inpatient signs and symptoms and factors associated with death among children aged ≤5 years admitted to two Ebola Management Centres in Sierra Leone, 2014: a retrospective cohort study

      Shah, Tejshri; Caleo, Grazia; Lokuge, Kamalini (2015-12-16)
      1. To describe the source case for children 2. To describe the viral load at presentation 3. To document the intervals between symptom onset and presentation for those who die and those who survive 4. To describe early symptoms of Ebola virus disease 5. To assess the association between risk factors and death
    • Research Protocol - Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study

      Shah, Tejshri; Greig, Jane; van der Plas, LM; Achar, J; Caleo, Grazia; Squire, James Sylvester; Turay, AS; Joshy, G; D’Este, C; Banks, E; et al. (2016-07)
      Background Médecins Sans Frontières (MSF) opened Ebola management centres (EMCs) in Sierra Leone in Kailahun in June, 2014, and Bo in September, 2014. Case fatality in the west African Ebola virus disease epidemic has been highest in children younger than 5 years. Clinical data on outcomes can provide important evidence to guide future management. However, such data on children are scarce and disaggregated clinical data across all ages in this epidemic have focussed on symptoms reported on arrival at treatment facilities, rather than symptoms and signs observed during admission. We aimed to describe the clinical characteristics of children aged 5 years and younger admitted to the MSF EMCs in Bo and Kailahun, and any associations between these characteristics and mortality. Methods In a retrospective cohort study, we included data from children aged 5 years and younger with laboratory-confirmed Ebola virus disease admitted to EMCs between June and December, 2014. We described epidemiological, demographic, and clinical characteristics and viral load (measured using Ebola virus cycle thresholds [Ct]), and assessed their association with death using Cox regression modelling. Findings We included 91 children in analysis; 52 died (57·1%). Case fatality was higher in children aged less than 2 years (76·5% [26/34]) than those aged 2–5 years (45·6% [26/57]; adjusted HR 3·5 [95% CI 1·5–8·5]) and in those with high (Ct<25) versus low (Ct≥25) viral load (81·8% [18/22] vs 45·9% [28/61], respectively; adjusted HR 9·2 [95% CI 3·8–22·5]). Symptoms observed during admission included: weakness 74·7% (68); fever 70·8% (63/89); distress 63·7% (58); loss of appetite 60·4% (55); diarrhoea 59·3% (54); and cough 52·7% (48). At admission, 25% (19/76) of children were afebrile. Signs significantly associated with death were fever, vomiting, and diarrhoea. Hiccups, bleeding, and confusion were observed only in children who died. Interpretation This description of the clinical features of Ebola virus disease over the duration of illness in children aged 5 years and younger shows symptoms associated with death and a high prevalence of distress, with implications for clinical management. Collection and analysis of age-specific data on Ebola is very important to ensure that the specific vulnerabilities of children are addressed.
    • Research Protocol - Mortality Rates above Emergency Threshold in Population Affected by Conflict in North Kivu, Democratic Republic of Congo, July 2012–April 2013

      Carrión Martín, A I; Bil, K; Salumu, P; Baabo, D; Singh, J; Kik, C; Lenglet, A; MSF Amsterdam; Médecin Inspecteur Provinciale, Goma, North Kivu, Democratic Republic of Congo; Zone de Santé, Walikale, North Kivu, Democratic Republic of Congo (2014-09-18)
      The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF) returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs), access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012–April 2013). In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR) was of 1.4/10,000 persons/day (CI95%: 1.2–1.7) and the under-five- mortality rate (U5MR) of 1.9/10,000 persons per day (CI95%: 1.3–2.5). The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4–42.9). Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2–75.4). Non Food Items (NFI) ownership was low: 69.0% (CI95%: 53.1–79.7) at least one 10 liter jerry can, 30.1% (CI95%: 24.3–36.5) of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period.
    • Research Protocol - Post-kala-azar Dermal Leishmaniasis (PKDL): a prospective observational study of the effectiveness and safety of an ambulatory short course treatment with AmBisome* 15 mg/kg total dose

      Ritmeijer, Koert; Kumar Das, Asish; Ahmed, Be-Nazir; den Boer, Margriet; Almeida, Patrick; Verputten, Meggy; MSF-Holland, Amsterdam, The Netherlands; MSF-Holland, Fulbaria, Bangladesh; CDC, (DGHS); MSF-Holland, Amsterdam, The Netherlands; MSF-Holland, Dhaka, Bangladesh; MSF-Holland, Amsterdam, The Netherlands (2014-06)
      General objective To evaluate the effectiveness and safety of PKDL treatment with AmBisome 15 mg/kg total dose, given over 15 days in 5 infusions (twice weekly) of 3mg/kg on an ambulatory basis in a primary health care setting. Primary objective: to evaluate the effectiveness of AmBisome 15 mg/kg total dose at 12 M Secondary objective: • Evaluate the safety of AmBisome 3mg/kg x 5 infusions (twice weekly) (15 mg/kg total dose) • Evaluate the occurrence of hypokalaemia • Evaluate at which point in time lesions start to respond to treatment.
    • Research Protocol - Prevalence of depression, anxiety and posttraumatic stress related symptoms in the Kashmir Valley – a cross sectional study, 2015

      Housen, Tambri; Shah, Showkat; Janes, Simon; Pintaldi, Giovanni; Lenglet, Annick; Ariti, Cono; MSF OCA, New Delhi, India; Kashmir University; MSF OCA, New Delhi, India; MSF OCA, Amsterdam, Netherlands; MSF OCA, Amsterdam, Netherlands;Manson Unit, MSF UK, London, UK (2015-07)
      Primary Objective: To estimate prevalence of mental health related problems, specifically depression/anxiety and posttraumatic stress symptoms in Kashmir and to determine the accessibility to mental health services. Study Design: Mixed methods research design incorporating cross-sectional household survey, clinical psychiatric interviews, key informant interviews and focus group discussions. Inclusion Criteria: Participants will be included if they can meet the following criteria: • 18 years of age or older. • Able to provide informed consent. Exclusion Criteria: Participants will be excluded from the study if they meet the following criteria: • Unable to provide verbal informed consent. • Choose to withdraw their consent. Intervention: The survey will be conducted in the Kashmiri language by interview enumeration. A sub-sample of the survey population will undergo a mini-international neuropsychiatric interview (MINI) by a trained interviewer. Key informant interviews and focus group discussions will occur concurrently with the household survey. Sample Size: 4800 probability sampled households from 10 districts, 12 households from each village. A sub-sample of 200 individuals who test positive on validated screening tests will be convenience sampled for formal psychiatric interview (MINI). Two focus group discussions will be held in each district and will be comprised of 8-10 convenience sampled participants. Primary Outcome Measure: • Point Prevalence of depression/anxiety and posttraumatic stress symptoms. • Qualitative data on access to mental health services and perceived needs.
    • Research Protocol - Secondary prophylaxis of visceral leishmaniasis relapses in HIV co-infected patients using pentamidine as a prophylactic agent: a prospective cohort study

      Diro, Ermias; van Griensven, Johan; Hailu, Asrat; Ritmeijer, Koert; Gryseels, Bruno; University of Gondar, Gondar, Ethiopia; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium; Addis Ababa University, Addis Ababa, Ethiopia; Médecins Sans Frontières, Amsterdam, The Netherlands; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium (2014-10)
    • Research Protocol - The Impact of a Tick-Sheet in Improving Interpretation Accuracy of Chest Radiographs by Non-Specialists in an HIV positive cohort

      Kosack, Cara; Bonnet, Maryline; Spijker, Saskia; Mesic, Anita; Joekes, Elizabeth; Médecins Sans Frontières – International; Epicentre; Médecins Sans Frontières – International; Médecins Sans Frontières – Holland; LSTM, UK (2014-06)
      Primary objective of this study: 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 non-specialists, in an HIV-positive cohort. Secondary objective: To determine whether the application of a tick-sheet reduces the inter-reader variability of CXR interpretation in a group.
    • Research Protocol - The practice of medical humanitarian emergency: ethnography of practitioners’ response to nutritional crisis

      Stellmach, Darryl; Ulijaszek, Stanley; Mol, Annemarie; Stringer, Beverley; University of Oxford, Oxford, UK; University of Oxford, Oxford, UK; University of Amsterdam, Amsterdam, The Netherlands; Médecins Sans Frontières UK, London, UK (2014-07)
      Overall Aim: To describe and understand the human and technological factors that contribute to the constitution of emergency as a named and actionable entity in the context of medical humanitarianism. Primary Objective: To describe how individual and institutional attitudes, tools, discretion and practices influence identification and response to emergency. Secondary Objective: To document ambiguities, uncertainties or structural barriers that impede the identification of and response to emergency.
    • Research Protocol - Understanding how communities interact with the Ebola intervention as it unfolds and the subsequent value of specific control measures for a sustained success in the response in Sierra Leone: a qualitative study

      Gray, Nell; Stringer, Beverley; Broeder, Rob; Jephcott, Freya; Perache, Andre Heller; Bark, Gina; Kremer, Ronald; MSF UK, London; MSF UK, London; MSF OCA, Sierra Leone; MSF OCA, Sierra Leone; MSF UK, London; MSF OCA, Amsterdam; MSF OCA, Amsterdam (2015-07-02)
      This study aims to provide a better understanding of community interaction with the Ebola response in Sierra Leone in order to inform programme strategies: • Describe community and local-level perspectives and attitudes toward the measures taken to control the Ebola outbreak, with consideration of how such measures may have been integrated into personal narratives over time; • Document gaps, barriers and influences that impact control measures; • Consider the subsequent value of control measures used to inform an effective future outbreak response.
    • Research Protocol - Uptake of household disinfection kits as an additional measure in response to a cholera outbreak in urban areas of Haiti

      Gartley, M; Valeh, Parastou; de Lange, R; DiCarlo, S; Viscusi, A; Lenglet, A; MSF Amsterdam (2013-12)
      Médecins Sans Frontières-Operational Centre Amsterdam piloted the distribution of household disinfection kits (HDKs) and health promotion sessions for cholera prevention in households of patients admitted to their cholera treatment centres in Carrefour, Port au Prince, Haiti, between December 2010 and February 2011. We conducted a follow-up survey with 208 recipient households to determine the uptake and use of the kits and understanding of the health promotion messages. In 61% of surveyed households, a caregiver had been the recipient of the HDK and 57.7% of households had received the HDKs after the discharge of the patient. Among surveyed households, 97.6% stated they had used the contents of the HDK after receiving it, with 75% of these reporting using five or more items, with the two most popular items being chlorine and soap. A significant (p < 0.05) increase in self-reported use items in the HDK was observed in households that received kits after 24 January 2011 when the education messages were strengthened. To our knowledge, this is the first time it has been demonstrated that during a large-scale cholera outbreak, the distribution of simple kits, with readily available cleaning products and materials, combined with health promotion is easy, feasible, and valued by the target population.
    • Retrospective mortality and baseline health survey in Kutupalong and Balukhali settlement camps, Bangladesh

      Siddiqui, Ruby; White, Kate; Guzek, John; MSF-OCA (2018-07)
      2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events 2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events
    • Retrospective mortality and baseline health survey in Ofua village, Rhino settlement camp, Uganda

      Siddiqui, M Ruby; Cramond, Vanessa; Barre, Ibrahim; Johnson, Derek; MSF-OCA (2018-07)
      OBJECTIVES 2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To estimate the size of the population in Rhino (Ofua) settlement camp  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenAfriVac, DPT-Hib-HepB (Pentavalent) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events  To determine the coverage of Long-Lasting Insecticide Treated bedNets (LLITNs)
    • Retrospective mortality and baseline health survey in Palorinya settlement camp, Uganda

      Siddiqui, M Ruby; Cramond, Vanessa; Goldberg, Jacob; Guzek, John; MSF-OCA (2018-07)
      2. OBJECTIVES 2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To estimate the size of the population in Palorinya settlement camp  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenAfriVac, DPT-Hib-HepB (Pentavalent) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events  To determine the coverage of Long-Lasting Insecticide Treated bedNets (LLITNs)
    • Retrospective mortality survey in the MSF catchment area in Fizi health zone, South Kivu, Democratic Republic of Congo

      Lenglet, Annick; Bil, Karla; Mandelkow, Jantina; MSF-OCA (2018-07-31)
      . OBJECTIVES 2.1. PRIMARY OBJECTIVES To estimate the crude mortality rate for the total population (host and IDP) and for children under five years of age in the health zone of Fizi, South Kivu, DRC, in order to understand the current health status of the population in this catchment area. 2.2. SECONDARY OBJECTIVES  To determine the prevalence of self-reported morbidities in the two weeks preceding the survey in household members;  To determine the frequency and reasons for displacement;  To assess access to health care;  To determine the main causes of deaths during the recall period;  To measure the incidence and types of direct violence experienced by the civilian population;  To evaluate household ownership of basic non-food items;