• Management of pregnant women infected with Ebola virus in a treatment centre in Guinea, June 2014

      Baggi, F M; Taybi, A; Kurth, A; Van Herp, M; Di Caro, A; Wolfel, R; Gunther, S; Decroo, T; Declerck, H; Jonckheere, S (European Centre for Disease Prevention and Control, 2014-12-11)
    • Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease

      Tayler-Smith, K; Zachariah, R; Manzi, M; van den Boogaard, W; Vandeborne, A; Bishinga, A; De Plecker, E; Lambert, V; Christiaens, B; Sinabajije, G; Trelles, M; Goetghebuer, S; Reid, T; Harries, A D (BioMed Central Ltd, 2013-08-21)
      In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000--2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
    • An obstetrician reborn

      Garry, R; Médecins Sans Frontières, Sydney, NSW, Australia. raygarry@btinternet.com (2013-07)
    • One Size Fits All? Standardised Provision of Care for Survivors of Sexual Violence in Conflict and Post-Conflict Areas in the Democratic Republic of Congo

      Loko Roka, J; Van den Bergh, R; Au, S; De Plecker, E; Zachariah, R; Manzi, M; Lambert, V; Abi-Aad, E; Nanan-N'Zeth, K; Nzuya, S; Omba, B; Shako, C; MuishaBaroki, D; Basimuoneye, J P; Moke, D A; Lampaert, E; Masangu, L; De Weggheleire, A (Public Library of Science, 2014-10-20)
      Outcomes of sexual violence care programmes may vary according to the profile of survivors, type of violence suffered, and local context. Analysis of existing sexual violence care services could lead to their better adaptation to the local contexts. We therefore set out to compare the Médecins Sans Frontières sexual violence programmes in the Democratic Republic of Congo (DRC) in a zone of conflict (Masisi, North Kivu) and post-conflict (Niangara, Haut-Uélé).
    • Peripartum infections and associated maternal mortality in rural Malawi

      van den Akker, T; de Vroome, S; Mwagomba, B; Ford, N; van Roosmalen, J; Thyolo District Health Office, Ministry of Health, Thyolo, Malawi; Medecins Sans Frontieres Operational Center Brussels, Brussels, Belgium; The Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; The Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands; Center for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa (Lippincott Williams & Wilkins, 2011-08)
      To assess associations between maternal mortality and severe morbidity and human immunodeficiency virus (HIV) infection, uptake of antiretroviral therapy, obstetric infections, and nonobstetric infections in a rural Malawian district, where the estimated HIV prevalence is 21%.
    • 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)
    • Prevalence of anaemia, syphilis and hepatitis B in pregnant women in Nausori, Fiji

      Tuinakelo, L R; Tayler-Smith, K; Khogali, M; Marks, G B (Public Health Action, 2013-03)
    • The prevention of mother-to-child HIV transmission programme and infant feeding practices.

      Hilderbrand, K; Goemaere, E; Coetzee, D; Infectious Diseases and HIV/AIDS Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town. (2003-10)
      Since the first cases of HIV transmission through breast-feeding were documented, a fierce debate has raged on appropriate guidelines for infant feeding in resource-poor settings. A major problem is determining when it is safe and feasible to formula-feed, as breast-milk protects against other diseases. A cross-sectional survey of 113 women attending the programme for the prevention of mother-to-child transmission in Khayelitsha, Cape Town, was conducted. Over 95% of women on the programme formula-fed their infants and did not breast-feed at all. Seventy per cent of women said that their infant had never had diarrhoea, and only 3% of children had had two episodes of diarrhoea. Focus groups identified the main reasons for not breast-feeding given by women to their families and those around them. Formula feeding is safe and feasible in an urban environment where sufficient potable water is available.
    • 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.
    • 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.
    • Responding to rape.

      Shanks, L; Ford, N; Schull, M; de Jong, K; Médecins Sans Frontières, Toronto, Canada. msfcan@msf.ca (Elsevier, 2001-01-27)
    • 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.
    • Severe acute maternal morbidity and associated deaths in conflict and post-conflict settings in Africa

      Tamura, M; Hinderaker, S G; Manzi, M; Van Den Bergh, R; Zachariah, R (TB Union, 2012-12)
    • Sexual violence in post-conflict Liberia: survivors and their care.

      Tayler-Smith, K; Zachariah, R; Hinderaker, S G; Manzi, M; De Plecker, E; Van Wolvelaer, P; Gil, T; Goetghebuer, S; Ritter, H; Bawo, L; Davis-Worzi, C; Medecins sans Frontieres, Medical Department, Operational Center Brussels, Luxembourg, Luxembourg  Centre for International Health, University of Bergen, Bergen, Norway  International Union against Tuberculosis and Lung Disease, Paris, France  Medecins sans Frontieres, Operational Center Brussels, Brussels, Belgium  Medecins sans Frontieres, Monrovia, Liberia  Ministry of Health and Social Welfare, Monrovia, Liberia  Ministry of Gender and Development, Monrovia, Liberia. (Blackwell, 2012-11-12)
      Using routine data from three clinics offering care to survivors of sexual violence (SV) in Monrovia, Liberia, we describe the characteristics of SV survivors and the pattern of SV and discuss how the current approach could be better adapted to meet survivors' needs. There were 1500 survivors seeking SV care between January 2008 and December 2009. Most survivors were women (98%) and median age was 13 years (Interquartile range: 9-17 years). Sexual aggression occurred during day-to-day activities in 822 (55%) cases and in the survivor's home in 552 (37%) cases. The perpetrator was a known civilian in 1037 (69%) SV events. Only 619 (41%) survivors sought care within 72 h. The current approach could be improved by: effectively addressing the psychosocial needs of child survivors, reaching male survivors, targeting the perpetrators in awareness and advocacy campaigns and reducing delays in seeking care.
    • Tackling female genital cutting in Somalia.

      Ford, N; Médecins Sans Frontières, 124-132 Clerkenwell Road, EC1R 5DJ, London, UK. (Elsevier, 2001-10-06)
    • 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.
    • Which anthropometric indicators identify a pregnant woman as acutely malnourished and predict adverse birth outcomes in the humanitarian context?

      Ververs, M-T; Antierens, A; Sackl, A; Staderini, N; Captier, V (Public Library of Science, 2013)
      Currently there is no consensus on how to identify pregnant women as acutely malnourished and when to enroll them in nutritional programmes. Médecins Sans Frontières Switzerland undertook a literature review with the purpose of determining values of anthropometric indicators for acute malnutrition that are associated with adverse birth outcomes (such as low birth weight (LBW)), pre-term birth and intra-uterine growth retardation (IUGR). A literature search in PUBMED was done covering 1 January 1995 to 12 September 2012 with the key terms maternal anthropometry and pregnancy. The review focused on the humanitarian context. Mid-upper-arm circumference (MUAC) was identified as the preferential indicator of choice because of its relatively strong association with LBW, narrow range of cut-off values, simplicity of measurement (important in humanitarian settings) and it does not require prior knowledge of gestational age. The MUAC values below which most adverse effects were identified were <22 and <23 cm. A conservative cut-off of <23 cm is recommended to include most pregnant women at risk of LBW for their infants in the African and Asian contexts.
    • 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.
    • 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.