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  • Female Genital Schistosomiasis and HIV: Research Urgently Needed to Improve Understanding of the Health Impacts of This Important Coinfection.

    O'Brien, DP; Ford, Nathan; Djirmay, AG; Calmy, A; Vitoria, M; Jensen, TO; Christinet, V (Lippincott Williams and Wilkins, 2019-04-15)
    Evidence suggests that there are important interactions between HIV and female genital schistosomiasis (FGS) that may have significant effects on individual and population health. However, the exact way they interact and the health impacts of the interactions are not well understood. In this article, we discuss what is known about the interactions between FGS and HIV, and the potential impact of the interactions. This includes the likelihood that FGS is an important health problem for HIV-positive women in Schistosoma-endemic areas potentially associated with an increased risk of mortality, cancer, and infertility. In addition, it may be significantly impacting the HIV epidemic in sub-Saharan Africa by making young women more susceptible to HIV. We call for immediate action and argue that research is urgently required to address these knowledge gaps and propose a research agenda to achieve this.
  • Removal of user fees and system strengthening improves access to maternity care, maternal and neonatal mortality in a district hospital in Lesotho

    Steele, SJ; Sugianto, H; Baglione, Q; Sedlimaier, S; Niyibizi, AA; Duncan, K; Hill, J; Brix, J; Philips, M; Van Cutsem, G; Shroufi, A (Blackwell Publishing Ltd, 2018-10-26)
    Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co-payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho.
  • Care in crisis

    Nicholl, J; Midwife, recently completed her sixth assignment working for Médecins Sans Frontières/Doctors Without Borders (MSF) (Mark Allen Healthcare, 2018-10-03)
  • Risk Factors for Vaginal Colonization and Relationship between Bacterial Vaginal Colonization and In-Hospital Outcomes in Women with Obstructed Labor in a Ugandan Regional Referral Hospital

    Ngonzi, J; Bebell, LM; Bazira, J; Fajardo, Y; Nyehangane, D; Boum, Y; Nanjebe, D; Boatin, A; Kabakyenga, J; Jacquemyn, Y; Van Geertruyden, JP; Riley, LE; Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Mbarara University of Science and Technology, Department of Microbiology, Mbarara, Uganda; Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda; Epicentre Mbarara Research Base, Mbarara, Uganda; Epicentre Mbarara Research Base, Mbarara, Uganda; Epicentre Mbarara Research Base, Mbarara, Uganda; Massachusetts General Hospital Center for Global Health, Boston, MA, USA; Mbarara University of Science and Technology, Institute of Maternal Newborn and Child Health, Mbarara, Uganda; Global Health Institute, University of Antwerp, Antwerp, Belgium; Global Health Institute, University of Antwerp, Antwerp, Belgium; Division of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA (Hindawi Publishing Corporation, 2018-09-20)
    Introduction . The proportion of women with severe maternal morbidity from obstructed labor is between 2 and 12% in resource-limited settings. Maternal vaginal colonization with group B streptococcus (GBS), Escherichia coli , and Enterococcus spp. is associated with maternal and neonatal morbidity. It is unknown if vaginal colonization with these organisms in obstructed labor women is associated with poor outcomes. Objectives . To determine whether vaginal colonization with GBS, E. coli , or Enterococcus is associated with increased morbidity among women with obstructed labor and to determine the risk factors for colonization and antibiotic susceptibility patterns. Methods . We screened all women presenting in labor to Uganda’s Mbarara Regional Referral Hospital maternity ward from April to October 2015 for obstructed labor. Those meeting criteria had vaginal swabs collected prior to Cesarean delivery and surgical antibiotic prophylaxis. Swabs were inoculated onto sterile media for routine bacterial culture and antimicrobial susceptibility testing. Results . Overall, 2,168 women were screened and 276 (13%) women met criteria for obstructed labor. Vaginal swabs were collected from 272 women (99%), and 170 (64%) were colonized with a potential pathogen: 49% with E. coli , 5% with GBS, and 8% with Enterococcus . There was no difference in maternal and fetal clinical outcomes between those colonized and not colonized. The number of hours in labor was a significant independent risk factor for vaginal colonization (aOR 1.02, 95% CI 1.00–1.03, P = 0.04 ). Overall, 38% of GBS was resistant to penicillin; 61% of E. coli was resistant to ampicillin, 4% to gentamicin, and 5% to ceftriaxone and cefepime. All enterococci were ampicillin and vancomycin susceptible. Conclusion . There was no difference in maternal or neonatal morbidity between women with vaginal colonization with E. coli , GBS, and Enterococcus and those who were not colonized. Duration of labor was associated with increased risk of vaginal colonization in women with obstructed labor.
  • High prevalence of ESBL-positive bacteria in an obstetrics emergency hospital and neonatal care unit—Haiti, 2016

    Chaintarli, K; Lenglet, A; Beauzile, BD; Senat-Delva, R; Mabou, MM; Martino, C; Berthet, M; Wong, S; Hopman, J (The Society for Healthcare Epidemiology of America, 2018-08-30)
    Patient colonization with extended-spectrum β-lactamase–producing gram-negative bacteria (ESBL-GNB) could serve as a potential reservoir for transmission of multidrug-resistant (MDR) bacteria in a hospital setting. Individuals colonized with ESBLEnterobacteriaceae are also known to be at a higher risk of ESBLGNB infection following their colonization.1 We encountered an outbreak of MDR Klebsiella pneumoniae in the neonatal care unit (NCU) of the Médecins Sans Frontiéres (MSF) obstetric emergency hospital in Port au Prince (CRUO), Haiti, between 2014 and 2015.2 As part of ongoing surveillance activities for MDR bacteria and in an effort to better target infection, prevention, and control (IPC) measures throughout the hospital, we conducted a point-prevalence survey to estimate the prevalence of colonization with ESBL-GNB and to identify risk factors for colonization with ESBL-GNB in women and neonates admitted to this hospital.
  • Delayed access to emergency obstetrical care among preeclamptic and non-preeclamptic women in Port-Au-Prince, Haiti

    Hutchinson, K; Bryant, M; Bachman DeSilva, M; Price, D; Sabin, L; Bryson, L; Jean Charles, R; Declercq, E (BMC, 2018-08-20)
    The primary objective of this comparative, cross-sectional study was to identify factors affecting delays in accessing emergency obstetric care and clinical consequences of delays among preeclamptic and non-preeclamptic women in Port-au-Prince, Haiti.
  • Wishful thinking versus operational commitment: is the international guidance on priority sexual and reproductive health interventions in humanitarian settings becoming unrealistic?

    Tran, NT; Schulte-Hillen, C (BioMed Central, 2018-05-29)
    Twenty-one years ago, a global consortium of like-minded institutions designed the landmark Minimum Initial Service Package (MISP) for sexual and reproductive health (SRH) to guide national and international humanitarian first responders in preventing morbidity and mortality at the onset of chaos, destruction, and high insecurity caused by disasters or conflicts. Since then, the MISP has undergone limited change and has become an international reference in humanitarian response. This article discusses our perspectives regarding the 2018 changes to the MISP that have created division among humanitarian field practitioners, academics, advocates, and development agencies. With more than 50 pages, the new MISP chapter dilutes key guidance and messages on the most life-saving activities, leaving actors with excessive room for interpretation as to which priority activities need to be first implemented. Consequently, non-life-saving interventions may take precedence over essential ones. Insecurity, scarce human and financial resources, logistics constrains, and other limitations imposed by field reality at the onset of a crisis must be considered. We strongly recommend that an institution with the mandate, legitimacy, and technical expertise in the review of guidelines reexamines the 2018 edition of the MISP. We urge experienced first-line responders, national actors, and relevant agencies to join efforts to ensure that the MISP remains focused on a very limited set of essential activities and supplies that are pragmatic, field-oriented, and, most importantly, immediately life-saving for people in need.
  • Provision of emergency obstetric care at secondary level in a conflict setting in a rural area of Afghanistan - is the hospital fulfilling its role?

    Lagrou, D; Zachariah, R; Bissell, K; Van Overloop, C; Nasim, M; Wagma, HN; Kakar, S; Caluwaerts, S; De Plecker, E; Fricke, R; Van den Bergh, R (BioMed Central, 2018-01-22)
    Provision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between. In a conflict-affected province of Afghanistan (Khost), we assessed the performance of an Médecins Sans Frontières (MSF) run CEmONC hospital without a primary care and referral system. Performance was assessed in terms of hospital utilisation for obstetric emergencies and quality of obstetric care.
  • Care Requirements for Clients Who Present After Rape and Clients Who Presented After Consensual Sex as a Minor at a Clinic in Harare, Zimbabwe, From 2011 to 2014

    Harrison, R; Pearson, L; Vere, M; Chonzi, P; Hove, B; Mabaya, S; Chigwamba, M; Nhamburo, J; Gura, J; Vandeborne, A; Simons, S; Lagrou, D; De Plecker, E; Van den Bergh, R (Public Library of Science, 2017-09-21)
    To describe the differences between clients presenting after rape and clients who have consented to sex as a minor to an SGBV clinic in Harare, Zimbabwe, and how these differences affect their care requirements.
  • Antimicrobial-Resistant Infections Among Postpartum Women at a Ugandan Referral Hospital

    Bebell, LM; Ngonzi, J; Bazira, J; Fajardo, Y; Boatin, AA; Siedner, MJ; Bassett, IV; Nyehangane, D; Nanjebe, D; Jacquemyn, Y; van Geertruyden, JP; Mwanga-Amumpaire, J; Bangsberg, DR; Riley, LE; Boum, Y (Public Library of Science, 2017-04-13)
    Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking.
  • A Live Term Intra-Abdominal Pregnancy in a Field Hospital: a Case Report

    Abdelrahman, S; Deeter, M; Muthusami, A; Peterson, TG; Wackenier, L (Oxford University Press, 2017-03-22)
    Abdominal pregnancy is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be challenging, especially in a resource-limited setting. We report a case of abdominal pregnancy that presented to Médecins Sans Frontières field hospital in Agok, South Sudan, with abdominal pain. Examination revealed a term pregnancy and a live fetus in transverse lie. The diagnosis of abdominal pregnancy was made intraoperatively, with successful management and delivery of a healthy baby.
  • Why Médecins Sans Frontières (MSF) Provides Safe Abortion Care and What That Involves

    Schulte-Hillen, C; Staderini, N; Saint-Sauveur, JF (BioMed Central, 2016-09-21)
    MSF responds to needs for the termination of pregnancy, including on request (TPR); it is part of the organization's work aimed at reducing maternal mortality and suffering; and preventing unsafe abortions in the countries where we work. Following the publication of "Why don't humanitarian organizations provide safe abortion care?" we offer an insight into MSF's experience over the past few years. The article looks at the legal concerns and proposes that the importance of addressing maternal mortality should replace them and the operational set-up and action organized in a way that mitigates risks. MSF took a policy decision on safe abortion care in 2004; the fact that care did not expand rapidly to relevant MSF projects came as a surprise, reflecting the important weight social norms around abortion have everywhere. The need to engage in an open dialogue with staff, relevant medical actors and at community level became more obvious. Finally the article looks some key lessons that have emerged for the organization as part of the effort to prevent ill health, maternal death and suffering caused by unwanted pregnancy and unsafe abortion.
  • Caesarean Sections in Rural Burundi: How Well Are Mothers Doing Two Years On?

    van den Boogaard, W; Manzi, M; De Plecker, E; Caluwaerts, S; Nanan-N'zeth, K; Duchenne, B; Etienne, W; Juma, N; Ndelema, B; Zachariah, R (International Union Against TB and Lung Disease, 2016-06-21)
    A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death.
  • Pregnant Women in War Zones

    Akol, AD; Caluwaerts, S; Weeks, AD (BMJ Publishing Group We regret that this article is behind a paywall., 2016-04-20)
  • Factors Related to Fetal Death in Pregnant Women with Cholera, Haiti, 2011-2014

    Schillberg, E; Ariti, C; Bryson, L; Delva-Senat, R; Price, D; GrandPierre, R; Lenglet, A (Center for Disease Control, 2016-01-01)
    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.
  • Care for victims of sexual violence, an organization pushed to its limits: The case of Médecins Sans Frontières

    Duroch, F; Schulte-Hillen, C (International Committee of the Red Cross/Cambridge University Press, 2015-09-09)
    Over the past ten years, Médecins Sans Frontières (MSF) has provided medical care to almost 118,000 victims of sexual violence. Integrating related care into MSF general assistance to populations affected by crisis and conflicts has presented a considerable institutional struggle and continues to be a challenge. Tensions regarding the role of MSF in providing care to victims of sexual violence and when facing the multiple challenges inherent in dealing with this crime persist. An overview of MSF’s experience and related reflection aims to share with the reader, on the one hand,the complexity of the issue, and on the other, the need to continue fighting for the provision of adequate medical care for victims of sexual violence,which despite the limitations is feasible.
  • Unregulated Usage of Labour-Inducing Medication in a Region of Pakistan with Poor Drug Regulatory Control: Characteristics and Risk Patterns

    Shah, S; Van den Bergh, R; Prinsloo, J R; Rehman, G; Bibi, A; Shaeen, N; Auat, R; Daudi, S M; Njenga, J W; Khilji, T B-U-D; Maïkéré, J; De Plecker, E; Caluwaerts, S; Zachariah, R; Van Overloop, C (Oxford University Press, 2015-08-13)
    In developing countries such as Pakistan, poor training of mid-level cadres of health providers, combined with unregulated availability of labour-inducing medication can carry considerable risk for mother and child during labour. Here, we describe the exposure to labour-inducing medication and its possible risks in a vulnerable population in a conflict-affected region of Pakistan.
  • Cholera in Pregnancy: A Systematic Review and Meta-Analysis of Fetal, Neonatal, and Maternal Mortality

    Tran, N-T; Taylor, R; Antierens, A; Staderini, N (Public Library of Science, 2015-07-15)
    Maternal infection with cholera may negatively affect pregnancy outcomes. The objective of this research is to systematically review the literature and determine the risk of fetal, neonatal and maternal death associated with cholera during pregnancy.
  • Improving Men's Participation in Preventing Mother-to-Child Transmission of HIV as a Maternal, Neonatal, and Child Health Priority in South Africa

    van den Berg, W; Brittain, K; Mercer, G; Peacock, D; Stinson, K; Janson, H; Dubula, V (Public Library of Science, 2015-04-07)
    Wessel van den Berg and colleagues outline how increasing male partner involvement in efforts to reduce mother-to-child HIV transmission in South Africa may improve maternal and infant outcomes.
  • An Analysis of Cesarean Section and Emergency Hernia Ratios as Markers of Surgical Capacity in Low-Income Countries Affected by Humanitarian Emergencies from 2008 - 2014 at Médecins sans Frontières Operations Centre Brussels Projects

    Stewart, B; Wong, E; Papillon-Smith, J; Trelles Centurion, M A; Dominguez, L; Ao, S; Jean-Paul, B K; Kamal, M; Helmand, R; Naseer, A; Kushner, A L (Public Library of Science, 2015-03-27)
    Surgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis.

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