• 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; et al. (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.
    • Cohort analysis of antenatal care and delivery outcomes in pregnancy: a basis for improving maternal health

      Harries, A D; Jahn, A; Ben-Smith, A; Gadabu, O J; Douglas, G P; Seita, A; Khader, A; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2014-06-21)
    • A cross-sectional study of indications for cesarean deliveries in Médecins Sans Frontières facilities across 17 countries

      Groen, Reinou S; Trelles, Miguel; Caluwaerts, Severine; Papillon-Smith, Jessica; Noor, Saiqa; Qudsia, Burhani; Ndelema, Brigitte; Kondo, Kalla M; Wong, Evan G; Patel, Hiten D; et al. (Elsevier Ltd - We regret that this article is behind a paywall., 2015-02-28)
      To review the major indications for cesareans performed by Médecins Sans Frontières (MSF) personnel from the Operational Center Brussels.
    • 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.
    • Description and Consequences of Sexual Violence in Ituri Province, Democratic Republic of Congo

      Duroch, F; McRae, M; Grais, R; Médecins Sans Frontières (Operational Centre Geneva), Geneva, Switzerland; Epicentre, Paris, France; Harvard Humanitarian Initiative, Cambridge, Massachusetts, US; Geneva Center for Education and Research in Humanitarian Action (CERAH), University of Geneva, Geneva, Switzerland (2011-04-19)
      ABSTRACT: BACKGROUND: The war in eastern Democratic Republic of Congo has been the subject of numerous studies related to the problem of sexual violence. Historically, such violence is known to be part of strategic war plans to conquer and destroy communities, but it is now unfortunately prevalent in times of relative calm. METHODS: We describe the characteristics and consequences of sexual violence in Ituri province of Democratic Republic of Congo through the retrospective analysis of 2,565 patients who received medical care in the Medecins Sans Frontieres sexual violence clinic in the capital of Ituri province, Bunia, between September 2005 and December 2006. Using a standardised questionnaire, we report patients' demographics, number and status of aggressor(s), forced detention and violent threats among other variables for all patients presenting for medical consultation after a sexually violent event during this period. RESULTS: Ninety-six percent of our cohort were female and 29.3% minors, 18-29 years was the most represented age group. Acts of sexual violence (n= 2,565) were reported to be mainly perpetrated by men with military affiliations (73%), although civilians were implicated in 21% of crimes. The attack was perpetrated by two or more persons in over 74% of cases and most commonly perpetrators were unknown armed males, (87.2%). Male victims accounted for 4% (n=103) of our cohort. Forty-eight percent of our patients reported being attacked whilst performing daily domestic duties outside the home and 18% of victims being detained by their perpetrators, the majority of whom were held for less than 2 weeks (61.6%). CONCLUSIONS: The characteristics of sexually violent acts in Ituri province during this period cannot be simply explained as a 'weapon of war' as described in the literature, meaning the use of sexual violence within a military strategy where it is employed under the orders of a commander to harm a particular community. Whilst the majority of aggressions were by armed men there was an important proportion in which civilian perpetrators were implicated. This type of violence has become part of the general characteristics of violence in this war-torn population. Sometimes, as a means for some military factions to acquire remuneration with impunity and for some civilians, a means to counteract confronting, changing social norms occurring during chronic conflict.
    • Do non-monetary incentives for pregnant women increase antenatal attendance among Ethiopian pastoralists?

      Khogali, M; Zachariah, R; Reid, A J; Alipon, S C; Zimble, S; Gbane, M; Etienne, W; Veerman, R; Hassan, A; Harries, A D (International Union Against Tuberculosis and Lung Disease, 2014-03)
      In a pastoralist setting in Ethiopia, we assessed changes in attendance between the first and subsequent antenatal care (ANC) visits following the implementation of non-monetary incentives in a primary health care centre over a 3-year period from October 2009 to September 2012. Incentives included the provision of a bar of soap,a bucket, a mosquito net, sugar, cooking oil, a jerrycan and a delivery kit. The first ANC visits increased by 48% in the first year to 60% in the second. Subsequent visits did not show a similar pattern due to ruptures in incentive stocks. Incentives appear to increase ANC attendance; however, ruptures in stock should be avoided to sustain the effect.
    • Ebola in Africa: beyond epidemics, reproductive health in crisis

      Delamou, A; Hammonds, R M; Caluwaerts, S; Utz, B; Delvaux, T (Elsevier, 2014-12-13)
    • Effectiveness of the first district-wide programme for the prevention of mother-to-child transmission of HIV in South Africa.

      Coetzee, D; Hilderbrand, K; Boulle, A; Draper, B; Abdullah, F; Goemaere, E; Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. dcoetzee@phfm.uct.ac.za (WHO, 2005-07)
      OBJECTIVE: The aim of this study was to estimate the field efficacy of the first routine programme for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) initiated in South Africa, in the subdistrict of Khayelitsha. METHODS: A consecutive sample of 658 mother-infant pairs, identified from the PMTCT register from 1 March to 30 November 2003, were identified for enrolment in this study. Details of the regimen received were established and HIV status of the infants at between 6 and 10 weeks of age was determined by qualitative DNA polymerase chain reaction. Zidovudine (AZT) was provided antenatally from week 34 of gestation and during labour. Infant formula milk was-offered to mothers who chose not to breastfeed. The protocol was amended in July 2003 such that women who had received < 2 weeks of treatment with AZT were given a single dose of nevirapine (NVP) at the onset of labour, and the infant received a weight-adjusted dose of NVP within 72 h of delivery. RESULTS: Of the 535 mother-infant pairs (81%) eventually included in the study, 410 (77%) received an effective PMTCT intervention according to the protocol. The rate of transmission of HIV from mother to child was 8.8% (95% confidence interval (CI), 6.2-10.9). A maternal age of > 25 years was the only significant independent risk factor for transmission (odds ratio, 2.12; 95% CI, 1.14-4.07). CONCLUSION: The results of this study demonstrate the feasibility and effectiveness of a large-scale PMTCT programme in an urban public-sector setting.
    • Effects of a refugee-assistance programme on host population in Guinea as measured by obstetric interventions.

      Van Damme, W; De Brouwere, V; Boelaert, M; Van Lerberghe, W; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. wvdamme@itg.be (Elsevier, 1998-05-30)
      BACKGROUND: Since 1990, 500000 people have fled from Liberia and Sierra Leone to Guinea, west Africa, where the government allowed them to settle freely, and provided medical assistance. We assessed whether the host population gained better access to hospital care during 1988-96. METHODS: In Guéckédou prefecture, we used data on major obstetric interventions performed in the district hospital between January, 1988, and August, 1996, and estimated the expected number of births to calculate the rate of major obstetric interventions for the host population. We calculated rates for 1988-90, 1991-93, and 1994-96 for three rural areas with different numbers of refugees. FINDINGS: Rates of major obstetric interventions for the host population increased from 0.03% (95% CI 0-0.09) to 1.06% (0.74-1.38) in the area with high numbers of refugees, from 0.34% (0.22-0.45) to 0.92% (0.74-1.11) in the area with medium numbers, and from 0.07% (0-0.17) to 0.27% (0.08-0.46) in the area with low numbers. The rate ratio over time was 4.35 (2.64-7.15), 1.70 (1.40-2.07), and 1.94 (0.97-3.87) for these areas, respectively. The rates of major obstetric interventions increased significantly more in the area with high numbers of refugees than in the other two areas. INTERPRETATION: In areas with high numbers of refugees, the refugee-assistance programme improved the health system and transport infrastructure. The presence of refugees also led to economic changes and a "refugee-induced demand". The non-directive refugee policy in Guinea made such changes possible and may be a cost-effective alternative to camps.
    • The epidemiology of rape and sexual violence in the platinum mining district of Rustenburg, South Africa: Prevalence, and factors associated with sexual violence.

      Steele, SJ; Abrahams, N; Duncan, K; Woollett, N; Hwang, B; O'Connell, L; van Cutsem, G; Shroufi, A (Public Library of Sciences, 2019-07-31)
      BACKGROUND: Estimates for the prevalence of rape and other forms of sexual violence (SV) vary in South Africa. This survey aimed to provide clarity by quantifying the prevalence of SV (forced sex or sexual acts) by 1) sexual partners, and 2) non-partners, and to describe factors associated with these outcomes among women (18-49 years) living in Rustenburg Municipality. MATERIALS AND METHODS: We conducted a cluster-randomized household survey (November-December 2015). Women were asked about their experiences of SV, associated attitudes and behaviours, and access to services. Logistic regression was used to determine factors associated with partner and non-partner SV. RESULTS: Of eligible households, 83·1% (1700/2044) participated. Of 966 women invited, 836 participated (86·5%). Average age of participants was 31.6 years (95%CI: 30·9, 32·4) with 45% having completed at least secondary school, and 60% unemployed or looking for work. Lifetime prevalence of SV was 24.9% (95%CI: 21·7-28·5), reaching 9.0% (95% CI: 6·6-12·1) by age 15. Almost one third told no one of their SV experiences. Factors related to financial dependence were associated with SV by a partner. History of termination of pregnancy increased the likelihood of SV by a non-partner as an adult. Women who experienced SV in childhood or as an adult were more likely to experience SV from a different type of perpetrator than those who did not. CONCLUSIONS: We found a high prevalence of SV, including during childhood, in this setting, with limited access to care. This and the high morbidity attributed to SV calls for increased service provision.
    • Factors associated with severe preeclampsia and eclampsia in Jahun, Nigeria

      Guerrier, G; Oluyide, B; Keramarou, M; Grais, R (DovePress, 2013)
      To explore traditional herbal medicines as potential risk factors of severe preeclampsia and eclampsia in Nigeria.