• Acceptability and technical problems of the female condom amongst commercial sex workers in a rural district of Malawi.

      Zachariah, R; Harries, A D; Buhendwa, L; Spielmann, M P; Chantulo, A; Bakali, E; Médecins Sans Frontières - Luxembourg, Thyolo district, Thyolo, Malawi. zachariah@internet.lu (2003-10)
      A study was conducted among commercial sex workers (CSWs) in rural southern Malawi, in order to (a) assess the acceptability of the female condom and (b) identify common technical problems and discomforts associated with its use. There were 88 CSWs who were entered into the study with a total of 272 female condom utilizations. Eighty-six (98%) were satisfied with the female condom, 80% preferred it to the male condom and 92% were ready to use the device routinely. Of all the utilizations, the most common technical problem was reuse of the device with consecutive clients, 6% after having washed it, and 2% without any washing or rinsing. The most common discomfort that were reported included too much lubrication (32%), device being too large (16%), and noise during sex (11%). This study would be useful in preparing the introduction of the female condom within known commercial sex establishments in Malawi.
    • Acceptability and utilization of a lipid-based nutrient supplement formulated for pregnant women in rural Niger: a multi-methods study

      Isanaka, S; Kodish, SR; Mamaty, AA; Guindo, O; Zeilani, M; Grais, RF (BioMed Central, 2019-07-01)
      Background In food insecure settings, it may be difficult for pregnant women to meet increased nutritional needs through traditional diets. A promising new strategy to fill nutrient gaps in pregnancy involves the provision of lipid-based nutrient supplements (LNS). We aimed to assess the acceptability and utilization of a 40 g LNS formulation (Epi-E) with increased micronutrient content relative to the recommended daily allowance among pregnant women in rural Niger. Methods We conducted a two-part, multi-methods study among pregnant women presenting to antenatal care in Madarounfa, Niger during two periods (Ramadan and non-Ramadan). Part 1 included two LNS test meals provided at the health center, and Part 2 included a 14-day home trial to simulate more realistic conditions outside of the health center. Open- and closed-ended questions were used to assess organoleptic properties of Epi-E using a 5-point hedonic scale after the test meals, as well as utilization and willingness to pay for Epi-E after the 14-day home trial. Results Participants consumed more than 90% of the test meal in both periods. Epi-E was rated highly in terms of overall liking, color, taste and smell during test meals in both periods (median 5/5 for all); only time, mode and frequency of consumption varied between Ramadan and non-Ramadan periods in observance of daily fasting during the holy month. Conclusion Epi- E, a 40 g LNS formulation with increased micronutrient content, was highly acceptable among pregnant women in rural Niger, and utilization was guided by household and individual considerations that varied by time period. This formulation can be further tested as a potential strategy to improve the nutritional status of pregnant women in this context.
    • Achieving the Millennium Development Goal of reducing maternal mortality in rural Africa: an experience from Burundi.

      Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; Van den Bergh, R; De Plecker, E; Lambert, V; Nicolai, M; Goetghebuer, S; Christaens, B; Ndelema, B; Kabangu, A; Manirampa, J; Harries, A D; Medecins sans Frontieres, Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg. (2012-11-20)
      OBJECTIVES: To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. METHODS: The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi. RESULTS: In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100 000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100 000 live births). CONCLUSION: Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa.
    • Adverse events associated with nevirapine use in pregnancy: a systematic review and meta-analysis

      Ford, N; Calmy, A; Andrieux-Meyer, I; Hargreaves, S; Mills, E J; Shubber, Z; Médecins Sans Frontières, Geneva, Switzerland. nathan.ford@msf.org (Lippincott Williams & Wilkins, 2013-04-24)
      The risk of adverse drug events associated with nevirapine (NVP) is suggested to be greater in pregnant women. We conducted a systematic review and meta-analysis of severe adverse events in HIV-positive women who initiated NVP while pregnant.
    • An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality

      Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; De Plecker, E; Lambert, V; Nicolai, M; Goetghebuer, S; Christiaens, B; Ndelema, B; Kabangu, A; Manirampa, J; Harries, A D; Medical department Operational Research, Medecins sans Frontieres, Luxembourg. katie_harries@yahoo.co.uk (2013-08)
      In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections.
    • 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.
    • 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.
    • Barriers and facilitators to combined ART initiation in pregnant women with HIV: lessons learnt from a PMTCT B+ pilot program in Swaziland

      Parker, L A; Jobanputra, K; Okello, V; Nhlangamandla, M; Mazibuko, S; Kourline, T; Kerschberger, B; Pavlopoulos, E; Teck, R (Lippincott Williams & Wilkins, 2015-01-26)
      In January 2013, Swaziland launched a PMTCT B+ implementation study in rural Shiselweni. We aimed to identify patient and health service determinants of combined antiretroviral therapy (ART) initiation, to help guide national implementation of PMTCT B+.
    • Breast Tuberculosis in Women: A Systematic Review

      Quaglio, G; Pizzol, D; Isaakidis, P; Bortolani, A; Tognon, F; Marotta, C; Di Gennaro, F; Putoto, G; Olliaro, P (American Society of Tropical Medicine and Hygiene, 2019-05-20)
      Breast tuberculosis (TB) is rarely reported and poorly described. This review aims to update the existing literature on risk factors, clinical presentations, constitutional symptoms, diagnostic procedures, and medical and surgical treatments for breast TB. In all, 1,478 cases of breast TB were collected. Previous history of TB was reported in 19% of cases. The most common clinical appearance of the lesion was breast lump (75%). The most common associated finding was axillary lymphadenitis (33%) followed by sinus or fistula (24%). The most common symptoms were pain and fever, reported in 42% and 28% of cases, respectively. The most used diagnostic method was fine-needle aspiration cytology (32%), followed by biopsy (27%), acid-fast bacteria Ziehl–Neelsen stain (26%), culture (13%), and polymerase chain reaction (2%). These tested positive in 64%, 93%, 27%, 26%, and 58% of cases, respectively. The majority (69%) of patients received a 6-month anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Surgery consisted of excision in 39% of cases, drainage in 23%, and mastectomy in 5%. The great majority of patients had a positive outcome. It often mimics breast cancer, which makes it difficult to diagnose. Most patients, when diagnosed in time, respond to antitubercular therapy alone.
    • Burundi: childbirth in a developing country.

      Chadney, S; Médecins Sans Frontières. (2006-05)
    • Cabergoline for suppression of puerperal lactation in a prevention of mother-to-child HIV-transmission programme in rural Malawi.

      Buhendwa, L; Zachariah, R; Teck, R; Massaquoi, M; Kazima, J; Firmenich, P; Harries, A D; Medecins sans Frontieres, Thyolo District, Malawi. (Royal Society of Medicine, 2008-01)
      This study shows that cabergoline (single oral-dose) is an acceptable, safe and effective drug for suppressing puerperal lactation. It could be of operational benefit not only for artificial feeding, but also for weaning in those that breast-feed within preventive mother-to-child HIV transmission programmes in resource-limited settings.
    • 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.
    • Can non-monetary incentives increase health facility deliveries? The experience in Thyolo District, Malawi

      van den Akker, T; Radge, G; Mateyu, A; Mwagomba, B; Bemelmans, M; Reid, T (2011-09)
    • 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.
    • 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)
    • 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.
    • Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres.

      Chu, K; Cortier, H; Maldonado, F; Mashant, T; Ford, N; Trelles, M; Médecins sans Frontières, Johannesburg, South Africa. kathryn.chu@joburg.msf.org (2012)
      The World Health Organization considers Cesarean section rates of 5-15% to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1-2% reported in sub-Saharan Africa. This study reports Cesarean sections rates and indications in Democratic Republic of Congo, Burundi, and Sierra Leone, and describe the main parameters associated with maternal and early neonatal mortality.
    • Characteristics, medical management and outcomes of survivors of sexual gender-based violence, Nairobi, Kenya

      Buard, V; Van den Bergh, R; Tayler-Smith, K; Godia, P; Sobry, A; Kosgei, R J; Szumilin, E; Harries, A D; Pujades-Rodriguez, M (Public Health Action, 2013-06-21)
    • 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.
    • Cholera in Pregnancy: Outcomes from a Specialized Cholera Treatment Unit for Pregnant Women in Léogâne, Haiti

      Ciglenecki, I; Bichet, M; Tena, J; Mondesir, E; Bastard, M; Tran, N-T; Antierens, A; Staderini, N; Médecins sans Frontières, Geneva, Switzerland. (Public Library of Science, 2013-08-15)
      The association between cholera in pregnancy and negative fetal outcome has been described since the 19(th) century. However, there is limited published literature on the subject. We describe pregnancy outcomes from a specialized multidisciplinary hospital unit at the onset of a large cholera outbreak in Haiti in 2010 and 2011.