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  • Perceptions of Healthcare-Associated Infection and Antibiotic Resistance among Physicians Treating Syrian Patients with War-Related Injuries

    Älgå, A; Karlow Herzog, K; Alrawashdeh, M; Wong, S; Khankeh, H; Stålsby Lundborg, C (MDPI, 2018-12-01)
    Healthcare-associated infections (HAIs) constitute a major contributor to morbidity and mortality worldwide, with a greater burden on low- and middle-income countries. War-related injuries generally lead to large tissue defects, with a high risk of infection. The aim of this study was to explore how physicians in a middle-income country in an emergency setting perceive HAI and antibiotic resistance (ABR). Ten physicians at a Jordanian hospital supported by Médecins Sans Frontières were interviewed face-to-face. The recorded interviews were transcribed verbatim and analyzed by qualitative content analysis with an inductive and deductive approach. The participants acknowledged risk factors of HAI and ABR development, such as patient behavior, high numbers of injured patients, limited space, and non-compliance with hygiene protocols, but did not express a sense of urgency or any course of action. Overuse and misuse of antibiotics were reported as main contributors to ABR development, but participants expressed no direct interrelationship between ABR and HAI. We conclude that due to high patient load and limited resources, physicians do not see HAI as a problem they can prioritize. The knowledge gained by this study could provide insights for the allocation of resources and development of hygiene and wound treatment protocols in resource-limited settings.
  • This is not a drill

    Carenzo, L (Springer Link, 2018-11-14)
  • Antibiotic resistance in Palestine: an emerging part of a larger crisis

    Kanapathipillai, R; Malou, N; Baldwin, K; Marty, P; Rodaix, C; Mills, C; Herard, P; Saim, M (The BMJ, 2018-10-15)
  • Migrant and refugee populations: a public health and policy perspective on a continuing global crisis

    Abbas, M; Aloudat, T; Bartolomei, J; Carballo, M; Durieux-Paillard, S; Gabus, L; Jablonka, A; Jackson, Y; Kaojaroen, K; Koch, D; Martinez, E; Mendelson, M; Petrova-Benedict, R; Tsiodras, S; Christie, D; Saam, M; Hargreaves, S; Pittet, D (BMC, 2018-09-20)
    The 2015-2017 global migratory crisis saw unprecedented numbers of people on the move and tremendous diversity in terms of age, gender and medical requirements. This article focuses on key emerging public health issues around migrant populations and their interactions with host populations. Basic needs and rights of migrants and refugees are not always respected in regard to article 25 of the Universal Declaration of Human Rights and article 23 of the Refugee Convention. These are populations with varying degrees of vulnerability and needs in terms of protection, security, rights, and access to healthcare. Their health status, initially conditioned by the situation at the point of origin, is often jeopardised by adverse conditions along migratory paths and in intermediate and final destination countries. Due to their condition, forcibly displaced migrants and refugees face a triple burden of non-communicable diseases, infectious diseases, and mental health issues. There are specific challenges regarding chronic infectious and neglected tropical diseases, for which awareness in host countries is imperative. Health risks in terms of susceptibility to, and dissemination of, infectious diseases are not unidirectional. The response, including the humanitarian effort, whose aim is to guarantee access to basic needs (food, water and sanitation, healthcare), is gripped with numerous challenges. Evaluation of current policy shows insufficiency regarding the provision of basic needs to migrant populations, even in the countries that do the most. Governments around the world need to rise to the occasion and adopt policies that guarantee universal health coverage, for migrants and refugees, as well as host populations, in accordance with the UN Sustainable Development Goals. An expert consultation was carried out in the form of a pre-conference workshop during the 4th International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland, on 20 June 2017, the United Nations World Refugee Day.
  • Infection with high proportion of multidrug-resistant bacteria in conflict-related injuries is associated with poor outcomes and excess resource consumption: a cohort study of Syrian patients treated in Jordan

    Älgå, A; Wong, S; Shoaib, M; Lundgren, K; Giske, CG; Von Schreeb, J; Malmstedt, J (BioMed Central, 2018-05-22)
    Armed conflicts are a major contributor to injury and death globally. Conflict-related injuries are associated with a high risk of wound infection, but it is unknown to what extent infection directly relates to sustainment of life and restoration of function. The aim of this study was to investigate the outcome and resource consumption among civilians receiving acute surgical treatment due to conflict-related injuries. Patients with and without wound infections were compared.
  • Evaluating a Mental Health Program for Palestinian Refugees in Lebanon

    Yassin, N; Taha, A; Ghantous, Z; Atoui, M; Forgione, F (SpringerLink, 2017-09-15)
    Medecins sans Frontière, an international non-governmental organization, initiated a mental health program for Palestinian refugees living in Lebanon. To evaluate the impact of the program after its completion, focus groups were conducted with three target groups: (1) patients, (2) staff, and (3) local community stakeholders. Participants voiced overall satisfaction with the program. The program provided easy access, good quality care, decreased stigma, as perceived by participants, and revealed a sense of community contentedness. In addition, several short-term outcomes were achieved, such as increasing the numbers of patients visiting the center/ receiving mental health treatment. However, lack of planning for sustainability and proper procedures for hand-over of the program constituted a major downfall. Program discontinuation posed ethical dilemmas, common in provisional interventions in underprivileged refugee communities.
  • Migrants caught between tides and politics in the Mediterranean: an imperative for search and rescue at sea?

    Zamatto, F; Argenziano, S; Arsenijevic, J; Ponthieu, A; Bertotto, M; Di Donna, F; Harries, AD; Zachariah, R (BMJ Publishing Group, 2017-09-14)
  • The Modified South African Triage Scale System for Mortality Prediction in Resource-Constrained Emergency Surgical Centers: A Retrospective Cohort Study

    Massaut, J; Valles, P; Ghismonde, A; Jacques, C; Louis, L; Zakir, A; Van den Bergh, R; Santiague, L; Massenat, R; Edema, N (BioMed Central, 2017-08-23)
    The South African Triage Scale (SATS) was developed to facilitate patient triage in emergency departments (EDs) and is used by Médecins Sans Frontières (MSF) in low-resource environments. The aim was to determine if SATS data, reason for admission, and patient age can be used to develop and validate a model predicting the in-hospital risk of death in emergency surgical centers and to compare the model's discriminative power with that of the four SATS categories alone.
  • The Use of Interpreters in Medical Triage During a Refugee Mass-Gathering Incident in Europe

    Alexakis, L; Papachristou, A; Baruzzi, C; Konstantinou, A (Cambridge University Press, 2017-07-28)
    Introduction During a refugees' mass-gathering incident in Kos Island, Greece, Médecins Sans Frontières (MSF; Brussels, Belgium) teams provided emergency medical care. A case report of the event focusing on difficulties encountered by the interpreters during triage and emergency response was prepared.
  • Is the South African Triage Scale Valid for Use in Afghanistan, Haiti and Sierra Leone?

    Dalwai, M; Valles, P; Twomey, M; Nzomukunda, Y; Jonjo, P; Sasikumar, M; Nasim, M; Razaaq, A; Gayraud, O; Jecrois, P; Wallis, L; Tayler-Smith, K (BMJ Publishing Group Ltd, 2017-06-15)
    Objective To assess the validity of the South African Triage Scale (SATS) in four Médecins Sans Frontières (MSF)-supported emergency departments (ED, two trauma-only sites, one mixed site (both medical and trauma cases) and one paediatric-only site) in Afghanistan, Haiti and Sierra Leone. Methods This was a retrospective cohort study conducted between June 2013 and June 2014. Validity was assessed by comparing patients’ SATS ratings with their final ED outcome (ie, hospital admission, death or discharge). Results In the two trauma settings, the SATS demonstrated good validity: it accurately predicted an increase in the likelihood of mortality and hospitalisation across incremental acuity levels (p<0.001) and ED outcomes for ‘green’ and ‘red’ patients matched the predicted ED outcomes in 84%–99% of cases. In the mixed ED, the SATS was able to predict an incremental increase in hospitalisation (p<0.001) across both trauma and non-trauma cases. In the paediatric-only settings, SATS was able to predict an incremental increase in hospitalisation in the non-trauma cases only (p<0.001). However, 87% (non-trauma) and 94% (trauma) of ‘red’ patients in the mixed-medical setting were overtriaged and 76% (non-trauma) and 100% (trauma) of ‘green’ patients in the paediatric settings were undertriaged. Conclusion The SATS is a valid tool for trauma-only settings in low-resource countries. Its use in mixed settings seems justified, but context-specific assessments would seem prudent. Finally, in paediatric settings with endemic malaria, adding haemoglobin level to the SATS discriminator list may help to improve the undertriage of patients with malaria.
  • Mass Shelters: Inappropriate in Displacement

    Koscalova, A; Lelevrier, Y (Refugee Studies Centre, 2017-06)
  • Retrospective Mortality Among Refugees from the Central African Republic Arriving in Chad, 2014

    Coldiron, ME; Roederer, T; Llosa, AE; Bouhenia, M; Madi, S; Sury, L; Neuman, M; Porten, K (BioMed Central, 2017-05-15)
    The Central African Republic has known long periods of instability. In 2014, following the fall of an interim government installed by the Séléka coalition, a series of violent reprisals occurred. These events were largely directed at the country's Muslim minority and led to a massive displacement of the population. In 2014, we sought to document the retrospective mortality among refugees arriving from the CAR into Chad by conducting a series of surveys.
  • A Crisis of Protection and Safe Passage: Violence Experienced by Migrants/Refugees Travelling Along the Western Balkan Corridor to Northern Europe

    Arsenijević, J; Schillberg, E; Ponthieu, A; Malvisi, L; Ahmed, WAE; Argenziano, S; Zamatto, F; Burroughs, S; Severy, N; Hebting, C; de Vingne, B; Harries, AD; Zachariah, R (BioMed Central, 2017-04-16)
    Pushed by ongoing conflicts and pulled by the desire for a better life, over one million migrants/refugees transited Balkan countries and arrived in Europe during 2015 and early 2016. To curb this influx, European countries instituted restrictive migration policies often characterized by building of razor-wire border fences and border closures. Among migrants/refugees who received mental health care in Serbia while travelling through Balkan countries to Northern Europe, we assessed the prevalence and patterns of violent events experienced including physical trauma.
  • "Providing a Roof" and More to Communities Affected by Typhoon Haiyan in the Philippines: the Médecins Sans Frontières Experience

    Ali, E; Ferir, MC; Reid, T; Gray, H; Van Den Boogaard, W; Gonzales, C; Zachariah, R (Cambridge Core, 2016-12-15)
    Typhoon Haiyan hit the Philippines in November 2013 and left a trail of destruction. As part of its emergency response, Médecins Sans Frontières distributed materials for reconstructing houses and boats as standardized kits to be shared between households. Community engagement was sought and communities were empowered in deciding how to make the distributions. We aimed to answer, Was this effective and what lessons were learned?
  • Emergency Department Care For Trauma Patients In Settings Of Active Conflict Versus Urban Violence: All Of The Same Calibre?

    Valles, P; Van den Bergh, R; van den Boogaard, W; Tayler-Smith, K; Gayraud, O; Mammozai, BA; Nasim, M; Cheréstal, S; Majuste, A; Charles, JP; Trelles, M (Oxford University Press, 2016-11-03)
    Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts.
  • Sparks Creating Light? Strengthening Peripheral Disease Surveillance in the Democratic Republic of Congo

    Benedetti, G; Mossoko, M; Nyakio Kakusu, JP; Nyembo, J; Mangion, JP; Van Laeken, D; Van den Bergh, R; Van den Boogaard, W; Manzi, M; Kibango, WK; Hermans, V; Beijnsberger, J; Lambert, V; Kitenge, E (International Union Against TB and Lung Disease, 2016-06-21)
  • Dangerous Crossing: Demographic and Clinical Features of Rescued Sea Migrants Seen in 2014 at an Outpatient Clinic at Augusta Harbor, Italy

    Trovato, A; Reid, A; Takarinda, K C; Montaldo, C; Decroo, T; Owiti, P; Bongiorno, F; Di Carlo, S (BioMed Central, 2016-06-15)
    In recent years Europe has received an increasing influx of migrants, many of whom risked their lives crossing the Mediterranean Sea. In October 2013, Italy launched a search and rescue operation at sea in response to migrant deaths during the sea crossing. In August 2014, Médecins sans Frontières and the local Ministry of Health established an outpatient clinic at Augusta harbor, in Sicily, which received 26 % of total sea migrants arrived in Italy in 2014, to provide immediate medical assessment and care.
  • Be Near a Road: Humanitarian Practice and Displaced Persons in North Kivu

    Healy, S; Tiller, S (Oxford University Press We regret that this article is behind a paywall., 2016-06-01)
    In 2012, an uprising by the March 23 Movement in North Kivu led to significant internal displacement in Eastern Democratic Republic of the Congo. The humanitarian community’s strategy was to distribute assistance according to the principle of impartiality. A closer analysis, however, shows that assistance was not so much determined by need as by status and location – in other words, how people were displaced and their proximity to Goma had a large influence on the level of assistance they received. This article argues that such imbalances can be partly explained by policies adopted within the humanitarian community: first, by privileging the political considerations of the Congolese Government when deciding which groups of internally displaced persons would receive better levels of assistance and protection; secondly, through a growing unwillingness by many agencies to negotiate their own access to populations with all parties of the conflict; and thirdly, in an inflexibility towards programme financing and management, which added considerable bureaucratic delays and difficulties to the delivery of assistance. By reflecting on the choices made by aid agencies in the context of mass displacement, this article shows how humanitarianism can restrict rather than enhance the options of forcibly displaced populations.
  • The Subtle Art of Compromise and Reconciliation: a Tale from Lower Dir

    Malinverni, S (BMJ Publishing Group We regret that this article is behind a paywall., 2016-05-27)

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