• Conducting operational research within a non governmental organization: the example of Medecins Sans Frontieres

      Zachariah, R; Ford, N; Draguez, B; Yun, O; Reid, T; Médecins Sans Frontières, Medical Department (Brussels Operational Centre- Operational Research), 68 Rue de Gasperich, L-1617, Luxembourg. (Elsevier, 2010-03-02)
      Like many other non governmental organizations (NGOs) that provide assistance to vulnerable populations living in difficult and resource-limited settings, Médecins Sans Frontières (MSF) is confronted with situations for which proven, effective interventions are often lacking and/or where there is need for strong advocacy for improving medical care. As a result, MSF has become an important contributor to health research, and has dedicated resources to guide operational research by establishing its own Ethics Review Board, an innovation fund, an online publications repository and by regularly contributing to major scientific conferences. However, this increased research activity has led to concern that priorities and resources may be diverted away from the essential mandate of care provision for NGOs. In response, this article discusses the potential role operational research can play within medical NGOs such as MSF, and highlights the relevance of operational research, the essential elements of developing it within the organisation and some of the perceived barriers and solutions.
    • 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.
    • Is operational research delivering the goods? The journey to success in low-income countries

      Zachariah, R; Ford, N; Maher, D; Bissell, K; Van den Bergh, R; van den Boogaard, W; Reid, T; Castro, K G; Draguez, B; von Schreeb, J; et al. (Elsevier, 2012-02-09)
      Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge-the so-called know-do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational research and its relation with policy and practice, identify why operational research might fail to affect policy and practice, and offer possible solutions to address these shortcomings. We also propose measures of success for operational research. Adoption and use of these measures could help to ensure that operational research better changes policy and practice and improves health-care delivery and disease programmes.
    • Knowledge production in humanitarian crises: beware of the innovation trap

      Smith, J; Whitehouse, K; Blanchet, K (Elsevier, 2020-04-01)
    • Knowledge production in humanitarian crises: beware of the innovation trap

      Smith, J; Whitehouse, K; Blanchet, K (Elsevier, 2020-04-01)
    • New ways to measure the effects of armed conflict in civilian population

      Kadir, A; Garcia, DM; Romero, F (Elsevier, 2019-10-24)
    • Overlooking the Importance of Immunoassays - Authors' Reply

      Cnops, L; van Griensven, J; Honko, AN; Bausch, DG; Sprecher, A; Hill, CE; Colebunders, R; Johnson, JC; Griffiths, A; Palacios, GF; et al. (Elsevier, 2016-10-01)
    • The STREAM trial: missed opportunities and lessons for future clinical trials.

      Loveday, M; Reuter, A; Furin, J; Seddon, JA; Cox, H (Elsevier, 2019-04-01)
      Final results of the STREAM trial were presented at the 2018, 49th Union World Conference on Lung Health, held in The Hague, The Netherlands. STREAM is a randomised controlled trial comparing the 18–24 month WHO-recommended multidrug-resistant tuberculosis (MDR-TB) treatment regimen with a 9–12 month regimen similar to that first described in Bangladesh. 1 Under programmatic conditions, the longer regimen results in treatment success for approximately 50% of patients, 2 whereas the shorter 9–12 month regimen improved treatment success to 80% or higher in selected countries. 3 , 4 Because these countries had relatively low HIV prevalence and relatively high percentages of treatment success with the longer regimens, questions around generalisability were raised. 4 STREAM was a multi-million dollar undertaking that took almost 10 years from the time of study design until the release of final results. Given the time and costs involved it is essential to reflect on lessons learned, and what the trial results tell us to inform how we accumulate future evidence to guide MDR-TB treatment.