• 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.
    • Nurses graduating in Fiji between 2001 and 2010: sufficient supply for Fiji's health service demands?

      Aiyub, S.; Linh, N. N.; Tayler-Smith, K.; Khogali, M.; Bissell, K. (2013-03)
    • On Complicity and Compromise: A Précis

      Lepora, C; Goodin, RE (BMJ Publishing Group We regret that this article is behind a paywall., 2017-03-03)
    • On Complicity and Compromise: A Reply

      Lepora, C; Goodin, RE (BMJ Publishing Group, 2016-12-14)
    • An Open Source Pharma Roadmap

      Balasegaram, M; Kolb, P; McKew, J; Menon, J; Olliaro, P; Sablinski, T; Thomas, Z; Todd, MH; Torreele, E; Wilbanks, J (Public Library of Science, 2017-04-18)
      In an Essay, Matthew Todd and colleagues discuss an open source approach to drug development.
    • Operational research in malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV.

      Harries, Anthony D; Zachariah, Rony; Chimzizi, Rhehab; Salaniponi, Felix; Gausi, Francis; Kanyerere, Henry; Schouten, Erik J; Jahn, Andreas; Makombe, Simon D; Chimbwandira, Frank M; et al. (2011)
      ABSTRACT:
    • Out of (West) Africa-Who Lost in the End?

      Olliaro, Piero; Lasry, Estrella; Tiffany, Amanda (American Society of Tropical Medicine and Hygiene, 2014-12-15)
      On October 29, 2014, 4 days before the annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH) to be held in New Orleans, LA, meeting registrants received an e-mail letter from the Louisiana Department of Health and Hospitals stating "we have requested that any individuals that will be traveling to Louisiana following a trip to the West African countries of Guinea, Liberia, and Sierra Leone or have had contact with an Ebola-infected individual remain in a self-quarantine for the 21 days following their relevant travel history…we see no use in you traveling to New Orleans to simply be confined to your room." This communication made it clear that those recently in countries experiencing the 2014 Ebola epidemic would not be able to participate in the meeting. The ASTMH sent their own communication stating that the Society did not agree with the State's policy, but had no choice but to abide. However inconvenient and upsetting this decision might have been, what really matters transcends the mere disturbance of long-planned schedules. More broadly, we lost on five levels.
    • Partnerships, Not Parachutists, for Zika Research

      Heymann, DL; Liu, J; Lillywhite, L (Massachusetts Medical Society, 2016-03-09)