• In Resource-Limited Settings Good Early Outcomes Can be Achieved in Children Using Adult Fixed-Dose Combination Antiretroviral Therapy.

      O'Brien, D; Sauvageot, D; Zachariah, R; Humblet, P; AIDS Working Group, Medecins Sans Frontieres, Plantage Middenlaan 14, 1001 EA Amsterdam, The Netherlands. daniel.obrien@amsterdam.msf.org (2006-10-03)
      OBJECTIVES: To (a) determine early treatment outcomes and (b) assess safety in children treated with adult fixed-dose combination (FDC) antiretroviral tablets. SETTING: Sixteen Medecins Sans Frontieres (MSF) HIV programs in eight countries in resource-limited settings (RLS). METHODS: Analysis of routine program data gathered June 2001 to March 2005. RESULTS: A total of 1184 children [median age, 7 years; inter-quartile range (IQR), 4.6-9.3] were treated with antiretroviral therapy (ART) of whom 616(52%) were male. At ART initiation, Centres for Disease Control stages N, A, B and C were 9, 14, 38 and 39%, respectively. Children were followed up for a median period of 6 months (IQR, 2-12 months). At 12 months the median CD4 percentage gain in children aged 18-59 months was 15% (IQR, 6-18%), and the percentage with CD4 gain < 15% was reduced from 85% at baseline to 11%. In those aged 60-156 months, median CD4 cell count gain was 275 cells/microl (IQR, 84-518 cells/microl), and the percentage with CD4 < 200 cells/mul reduced from 51% at baseline to 11%. Treatment outcomes included; 1012 (85%) alive and on ART, 36 (3%) deaths, 15 (1%) stopped ART, 89 (8%) lost to follow-up, and 31 (3%) with unknown outcomes. Overall probability of survival at 12 months was 0.87 (0.84-0.89). Side effects caused a change to alternative antiretroviral drugs in 26 (2%) but no deaths. CONCLUSIONS: Very satisfactory early outcomes can be achieved in children in RLS using generic adult FDC antiretroviral tablets. These findings strongly favour their use as an "interim solution" for scaling-up ART in children; however, more appropriate pediatric antiretroviral drugs remain urgently needed.
    • In search of the 'new informal legitimacy' of Médecins Sans Frontières

      Calain, Philippe; Unité de Recherche sur les Enjeux et Pratiques Humanitaires (UREPH), Médecins Sans Frontières-Switzerland (Oxford University Press, 2011-12-30)
      For medical humanitarian organizations, making their sources of legitimacy explicit is a useful exercise, in response to: misperceptions, concerns over the 'humanitarian space', controversies about specific humanitarian actions, challenges about resources allocation and moral suffering among humanitarian workers. This is also a difficult exercise, where normative criteria such as international law or humanitarian principles are often misrepresented as primary sources of legitimacy. This essay first argues for a morally principled definition of humanitarian medicine, based on the selfless intention of individual humanitarian actors. Taking Médecins Sans Frontières (MSF) as a case in point, a common source of moral legitimacy for medical humanitarian organizations is their cosmopolitan appeal to distributive justice and collective responsibility. More informally, their legitimacy is grounded in the rightfulness of specific actions and choices. This implies a constant commitment to publicity and accountability. Legitimacy is also generated by tangible support from the public to individual organizations, by commitments to professional integrity, and by academic alliances to support evidence-based practice and operational research.
    • The 'Indirect Costs' of Underfunding Foreign Partners in Global Health Research: A Case Study

      Crane, J; Andia B; Fouad, T; Boum, Y; R Bangsberg, D (Taylor & Francis, 2017-09-16)
      This study of a global health research partnership assesses how U.S. fiscal administrative policies impact capacity building at foreign partner institutions. We conducted a case study of a research collaboration between Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and originally the University of California San Francisco (UCSF), but now Massachusetts General Hospital (MGH). Our case study is based on three of the authors' experiences directing and working with this partnership from its inception in 2003 through 2015. The collaboration established an independent Ugandan non-profit to act as a local fiscal agent and grants administrator and to assure compliance with the Ugandan labour and tax law. This structure, combined with low indirect cost reimbursements from U.S. federal grants, failed to strengthen institutional capacity at MUST. In response to problems with this model, the collaboration established a contracts and grants office at MUST. This office has built administrative capacity at MUST but has also generated new risks and expenses for MGH. We argue that U.S. fiscal administrative practices may drain rather than build capacity at African universities by underfunding the administrative costs of global health research, circumventing host country institutions, and externalising legal and financial risks associated with international work.
    • An integrated approach of community health worker support for HIV/AIDS and TB care in Mozambique.

      Simon, S; Chu, K; Frieden, M; Candrinho, B; Ford, N; Schneider, H; Biot, M (2009-07-17)
      ABSTRACT: BACKGROUND: The need to scale up treatment for HIV/AIDS has led to a revival in community health workers to help alleviate the health human resource crisis in sub-Saharan Africa. Community health workers have been employed in Mozambique since the 1970s, performing disparate and fragmented activities, with mixed results. METHODS: A participant-observer description of the evolution of community health worker support to the health services in Angonia district, Mozambique. RESULTS: An integrated community health team approach, established jointly by the Ministry of Health and Medecins Sans Frontieres in 2007, has improved accountability, relevance, and geographical access for basic health services. CONCLUSIONS: The community health team has several advantages over 'disease-specific' community health worker approaches in terms of accountability, acceptability, and expanded access to care.
    • International health links manual

      Zachariah, Rony (Elsevier Ltd, 2010-03-01)
    • International nurse migration and HIV/AIDS.

      Lynch, S; Lethola, P; Ford, N (American Medical Association, 2008-09-03)
    • Interventions to Control Virus Transmission During an Outbreak of Ebola Hemorrhagic Fever: Experience from Kikwit, Democratic Republic of the Congo, 1995.

      Kerstiëns, B; Matthys, F; Médecins sans Frontières, Brussels, Belgium. bkerstie@jhsph.edu (Published by Infectious Diseases Society of America, 1999-02)
      On 6 May 1995, the Médecins sans Frontières (MSF) coordinator in Kinshasa, Democratic Republic of the Congo (DRC), received a request for assistance for what was believed to be a concurrent outbreak of bacillary dysentery and viral hemorrhagic fever (suspected Ebola hemorrhagic fever [EHF]) in the town of Kikwit, DRC. On 11 May, the MSF intervention team assessed Kikwit General Hospital. This initial assessment revealed a nonfunctional isolation ward for suspected EHF cases; a lack of water and electricity; no waste disposal system; and no protective gear for medical staff. The priorities set by MSF were to establish a functional isolation ward to deal with EHF and to distribute protective supplies to individuals who were involved with patient care. Before the intervention, 67 health workers contracted EHF; after the initiation of control measures, just 3 cases were reported among health staff and none among Red Cross volunteers involved in body burial.
    • Introductory note: The access to Essential Medicines Campaign.

      Kindermans, J M; Matthys, F; MSF International, 37 Rue de la Tourelle, 1040 Brussels, Belgium. (Wiley-Blackwell, 2001-11)
      To ensure access to essential medicines for disadvantaged populations there are at least three conditions to be met: drugs prices must be affordable for poor countries; research and development of drugs for tropical diseases must take place; and there is a need for health exceptions to trade agreements.
    • Keeping health facilities safe: one way of strengthening the interaction between disease-specific programmes and health systems.

      Harries, Anthony D; Zachariah, Rony; Tayler-Smith, Katie; Schouten, Erik J; Chimbwandira, Frank; Van Damme, Wim; El-Sadr, Wafaa M; International Union Against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org (2010-12)
      The debate on the interaction between disease-specific programmes and health system strengthening in the last few years has intensified as experts seek to tease out common ground and find solutions and synergies to bridge the divide. Unfortunately, the debate continues to be largely academic and devoid of specificity, resulting in the issues being irrelevant to health care workers on the ground. Taking the theme 'What would entice HIV- and tuberculosis (TB)-programme managers to sit around the table on a Monday morning with health system experts', this viewpoint focuses on infection control and health facility safety as an important and highly relevant practical topic for both disease-specific programmes and health system strengthening. Our attentions, and the examples and lessons we draw on, are largely aimed at sub-Saharan Africa where the great burden of TB and HIV ⁄ AIDS resides, although the principles we outline would apply to other parts of the world as well. Health care infections, caused for example by poor hand hygiene, inadequate testing of donated blood, unsafe disposal of needles and syringes, poorly sterilized medical and surgical equipment and lack of adequate airborne infection control procedures, are responsible for a considerable burden of illness amongst patients and health care personnel, especially in resource-poor countries. Effective infection control in a district hospital requires that all the components of a health system function well: governance and stewardship, financing,infrastructure, procurement and supply chain management, human resources, health information systems, service delivery and finally supervision. We argue in this article that proper attention to infection control and an emphasis on safe health facilities is a concrete first step towards strengthening the interaction between disease-specific programmes and health systems where it really matters – for patients who are sick and for the health care workforce who provide the care and treatment.
    • Knowledge, attitudes, and practices related to antibiotic use in Paschim Bardhaman District: A survey of healthcare providers in West Bengal, India.

      Nair, M; Tripathi, S; Mazumdar, S; Mahajan, R; Harshana, A; Pereira, A; Jimenez, C; Halder, D; Burza, S (Public Library of Science, 2019-05-31)
      INTRODUCTION: Antibiotic misuse is widespread and contributes to antibiotic resistance, especially in less regulated health systems such as India. Although informal providers are involved with substantial segments of primary healthcare, their level of knowledge, attitudes, and practices is not well documented in the literature. OBJECTIVES: This quantitative study systematically examines the knowledge, attitudes, and practices of informal and formal providers with respect to antibiotic use. METHODS: We surveyed a convenience sample of 384 participants (96 allopathic doctors, 96 nurses, 96 informal providers, and 96 pharmacy shopkeepers) over a period of 8 weeks from December to February using a validated questionnaire developed in Italy. Our team created an equivalent, composite KAP score for each respondent in the survey, which was subsequently compared between providers. We then performed a multivariate logistic regression analysis to estimate the odds of having a low composite score (<80) based on occupation by comparing allopathic doctors (referent category) with all other study participants. The model was adjusted for age (included as a continuous variable) and gender. RESULTS: Doctors scored highest in questions assessing knowledge (77.3%) and attitudes (87.3%), but performed poorly in practices (67.6%). Many doctors knew that antibiotics were not indicated for viral infections, but over 87% (n = 82) reported prescribing them in this situation. Nurses, pharmacy shopkeepers, and informal providers were more likely to perform poorly on the survey compared to allopathic doctors (OR: 10.4, 95% CI 5.4, 20.0, p<0.01). 30.8% (n = 118) of all providers relied on pharmaceutical company representatives as a major source of information about antibiotics. CONCLUSIONS: Our findings indicate poor knowledge and awareness of antibiotic use and functions among informal health providers, and dissonance between knowledge and practices among allopathic doctors. The nexus between allopathic doctors, pharmaceutical company representatives, and informal health providers present promising avenues for future research and intervention.
    • Legislation governing the US incentive scheme for neglected diseases needs to be amended, urges MSF

      Reid, Jennifer; Potet, Julien; Athersuch, Katy; Grovestock, Maisy; Sanjuan, Judit Rius (BMJ, 2014-09-30)
    • Letter from Peru. A Country Torn Apart by Violence.

      Veeken, H; Médecins sans Frontières, Amsterdam, The Netherlands. (Published by: BMJ Publishing Group Ltd, 1993-05-08)
    • Liberté, Égalité, Fraternité…Santé

      Baron, E (Elsevier, 2016-05-01)
      “We are not England, we are not France”, said Hillary Clinton about health-care insurance during a recent US presidential debate. European models of health care have their own history in which redistribution forms the cornerstone of social solidarity. Aiming to guarantee social cohesion, France's Etat Providence is rooted in models of a welfare state that developed in Germany and the UK. Ensuring universal health coverage and financed through payroll taxes, and increasingly through a general social contribution on all types of income, French health insurance is characterised by a strong redistributive scheme that benefits the poorest and the most sick.
    • Lurigancho Prison: Lima's "High School" for Criminality.

      Veeken, H; Médecins Sans Frontières, PO Box 10014, 1001 EA Amsterdam, Netherlands. hans-veeken@amsterdam.msf.org (Published by: BMJ Publishing Group Ltd, 2000-01-15)
    • A Medecins Sans Frontieres Ethics Framework for Humanitarian Innovation Plus Worked Case Studies

      Sheather, J; Jobanputra, K; Schopper, D; Pringle, J; Venis, S; Wong, S; Vincent-Smith, R (2016-10)
    • Medicine Is Still a Victim of War: We Desperately Need New Ideas

      Sheather, J; Pérache, A (BMJ Publishing Group, 2017-06-14)
      What we are witnessing is war without restraint. But what do we do to stop it?
    • Medicine Under Fire

      Sheather, J; Hawkins, V (BMJ Publishing Group, 2016-12-14)
    • Medicines without doctors: why the Global Fund must fund salaries of health workers to expand AIDS treatment.

      Ooms, G; Van Damme, W; Temmerman, M; Belgian section of Médecins Sans Frontières, Brussels, Belgium. gorik.ooms@brussels.msf.org (Public Library of Science, 2007-04)
    • Médecins Sans Frontières Experience in the Provision of Health Care in Complex Settings.

      Chan, E; Médecins Sans Frontières Hong Kong, Shop 5B, Laichikok Bay Garden, 272 Lai King Hill Road, Kowloon, Hong Kong. (2003-02)
    • Nagaland health assessment: High mortality rates and difficulty accessing essential health services in Lahe Township, Republic of the Union of Myanmar.

      Johnson, DC; Incerti, A; Thu Swe, K; Gignoux, E; Shwe Sin Ei, WL; Lwin Tun, T; Htun, C (Public Library of Science, 2019-05-14)
      INTRODUCTION: Lahe Township belongs to Myanmar`s Naga Self-administered Zone, which is one of the most remote and mountainous areas in Myanmar. However, the limited health data available for the region suggests that there could be neglected health needs that require attention. The purpose of this study was to assess the health status of the population of Lahe Township. METHODS: A cross-sectional study design incorporating a two-stage cluster sampling methodology recommended by the WHO was used to conduct a household level survey. In the first stage, 30 village clusters were selected from all villages situated in the Lahe Township through systematic sampling with probability of selection proportional to the population size of each village based on the 2014 Myanmar census. In the second stage, a GPS-based sampling method was used to select 30 households within a village cluster. The head of the household completed the survey for all members of the household. Questionnaires inquired about maternal health, mortality, morbidities, childhood nutritional status, access to health care, and water & sanitation. The resulting data was stratified by urban/rural status. RESULTS: Data was collected on 5,929 individuals living in 879 households, of which 993 individuals (16.7%) were children 5 years old or younger. The median age was 18.0 (IQR 8.0-35.0). Children 15 years old or younger represented 44.7% of the population. 19.8% of households reported at least 1 household member sick during the previous 30 days. The crude mortality rate per 10,000 people per day was 0.58 (95% CI: 0.48-0.69). The under 5 mortality per 10,000 people per day was 0.74 (95% CI: 0.50-1.06). Only 46.7% of households could access a hospital if there was a need. CONCLUSION: Our results demonstrate a high rate of mortality and the inability to access healthcare in Lahe Township, which should be addressed to prevent further deterioration of health.