This section contains MSF research protocols and their ethics reviews. These materials can be used, adapted and copied as long as citation of the source is given including the direct URL to the material. This work is licensed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/ https://i.creativecommons.org/l/by/4.0/88x31.png, Where pdf files have been uploaded, Word versions of these files may be available on request from the primary investigator - contact details are included in each protocol.

Recent Submissions

  • Health Seeking Behaviour in Kamrangirchar

    Jeroen van der Heijden; OCA (2018-09-28)
  • Retrospective mortality survey in the MSF catchment area in Fizi health zone, South Kivu, Democratic Republic of Congo

    Lenglet, Annick; Bil, Karla; Mandelkow, Jantina; MSF-OCA (2018-07-31)
    . OBJECTIVES 2.1. PRIMARY OBJECTIVES To estimate the crude mortality rate for the total population (host and IDP) and for children under five years of age in the health zone of Fizi, South Kivu, DRC, in order to understand the current health status of the population in this catchment area. 2.2. SECONDARY OBJECTIVES  To determine the prevalence of self-reported morbidities in the two weeks preceding the survey in household members;  To determine the frequency and reasons for displacement;  To assess access to health care;  To determine the main causes of deaths during the recall period;  To measure the incidence and types of direct violence experienced by the civilian population;  To evaluate household ownership of basic non-food items;
  • The Impact of a Tick-Sheet in Improving Interpretation Accuracy of Chest Radiographs by Non-Specialists in an HIV positive cohort

    Kosack, Cara; Mesic, Anita; Spijker, Saskia; Bonnet, Maryline; Joekes, Elizabeth; MSF-OCA (2018-07)
    Study objective 3.1 Primary objective To determine if the application of a tick-sheet after four hour training on its use and on CXR interpretation, improves the interpretation accuracy of CXRs for active TB, by nonspecialists, in an HIV-positive cohort. 3.2 Secondary objective To determine whether the application of a tick-sheet reduces the inter-reader variability of CXR interpretation in a group of non-specialists by comparing the inter-reader agreement before and after intervention.
  • Multi-site evaluation of HIV testing algorithms

    Kosack, Cara; Page, Anne-Laure; Shanks, Leslie; Chaillet, Pascale; Beelaert, Greet; Fransen, Katrien; Benson, Tumwesigye T.; Savane, Aboubacar; Nganga, Anne; MSF-OCA (2018-07)
    Objectives 3.1 Primary objective  To evaluate the overall and site-specific performance of the diagnostic algorithm performed at 6 MSF African program sites (i.e. using RDT results from the program sites) comparing using the diagnostic algorithm with ELISA, LIA, EIA-Ag and DNA-PCR as gold standard. 3.2 Secondary objectives  To evaluate the accuracy (sensitivity, specificity and predictive values) of Orgenics ImmunoComb® II HIV 1&2 Combfirm as an HIV confirmatory test.  To model different HIV RDT testing algorithms in order to define acceptable testing algorithm in each study setting (i.e. using RDT results from reference laboratory).  To determine the inter-user reliability of RDT testing (i.e. program sites vs. reference laboratory)  To evaluate accuracy of each HIV RDT measured by the sensitivity (SN), specificity (SP) and predictive values based on the prevalence of each testing centre.  To evaluate the accuracy of HIV testing using DPS samples for quality control purpose in HIV testing.  To assess whether additional confirmatory testing (i.e. Orgenics ImmunoComb® II HIV 1&2 Combfirm) improves the accuracy of the diagnostic algorithm used at the different study sites.  To perform a descriptive analysis on the differentiation between HIV 1 and 2 of the discriminative RDTs.
  • A randomized trial of AmBisome monotherapy and combination of AmBisome and miltefosine for the treatment of VL in HIV positive patients in Ethiopia followed by secondary VL prophylactic treatment with pentamidine

    Hailu, Asrat; Diro, Ermias; Kolja, Stille; Ritmeijer, Koert; Yifru, Sisay; Griensven, Johan van; Zijstra, Ed; Dorlo, Thomas; Strub-Wougaft, Nathalie; Bardonneau, Clelia; Ellis, Sally; Alexander, Neal; Edwards, Tansy; MSF-OCA (2018-07)
    General Objectives The overall objective of this trial is to identify a safe and effective treatment for VL in HIV coinfected patients. Primary Objective: To evaluate at day 29 assessment the efficacy of a combination regimen of AmBisome® + miltefosine and AmBisome® monotherapy in Ethiopian co-infected HIV + VL patients. Secondary Objectives: 1. To evaluate relapse-free survival at day 390 (after initial cure at day 29 or cure at day 58 after extended treatment). 2. To assess safety of the regimens. Other objectives: 1.To evaluate of viral load and CD4 count in all patients 2. To evaluate the pharmacokinetics of ARV, Ambisome and miltefosine and immune function markers in a subset of patients
  • Longitudinal cohort to evaluate Hepatitis C treatment effectiveness in HIV co-infected patients: Manipur, India

    Himanshu, M; Singh, Karam Romeo; Shougrakpam, Jeetesh; MSF-OCA (2018-07)
    4. OBJECTIVES Primary objective The primary objective of this study is to assess the effectiveness of HCV curative treatments in patients with chronic hepatitis C (CHC), co-infected with HIV in Manipur, India. Secondary objectives a. To describe the demographic, clinical and biological characteristics of patients with chronic hepatitis C and HIV co-infection b. To assess the effectiveness of HCV curative strategies in patients with chronic HCV, co-infected with HIV stratified by regimen and by site c. To identify risk factors associated with differing virological responses d. To assess the safety of HCV treatment e. To monitor the safety of HCV treatment in HIV co-infected patients f. To document the clinical and biological tolerance of the HCV treatment g. To assess the feasibility of HCV treatment h. To assess comparative performance of elastography (Fibroscan®) and APRI (AST to Platelet Ration Index), to evaluate liver fibrosis among HIV/HCV co-infected individuals i. To describe causes of non-eligibility for treatment j. To describe the clinical and biological evolution of co-infected patients, not eligible for HCV treatment k. To assess treatment adherence
  • Field evaluation of the performance of HCV Serological Rapid Diagnostic Tests among HCV/HIV co-infected patients

    Gupta, Ekta; Carnimeo, Valentina; Samukcham, Inao; Loarec, Anne; Mahajan, Supriya; Choudhary, Manish; Bastard, Mathieu; Maman, David; Page, Anne Laure; MSF-OCA (2018-07)
    P R O T O C O L S U M M A R Y  Title: Field evaluation of the performance of HCV Serological Rapid Diagnostic Tests among HCV/HIV co-infected patients.  Aim: To evaluate the performance of serological HCV Rapid Diagnostic Tests (RDTs) to identify tests adapted to resource-limited settings, reliable for HIV-infected patients.  Study design: Prospective evaluation of the performance of serological RDTs for HCV screening.  Primary objective: o To evaluate the performance of serological HCV RDTs under field conditions using as reference standard a combination of enzyme immunoassay (EIA) and recombinant immunoblot assay (RIBA) for the detection of antibodies anti-HCV in HIV infected patients.  Secondary objectives: o To describe the accuracy (sensitivity, specificity) of the RDTs as screening tests o To describe the performance of the RDTs according to the HCV genotype and HCV VL o To describe the performance of the RDTs according to the CD4 counts and HIV VL o To describe the performance of the RDTs in presence of HBV co-infection (presence of antigen anti-HBs (HBsAg)) o To describe the operational characteristics of the tests including ease of use, technical complexity and inter-reader variability. o To evaluate predictive values of each HCV RDT based on the prevalence of the testing center.
  • Determination of the most accurate diagnostic approach for the diagnosis of human brucellosis in Lankien, South-Sudan

    Kosack, Cara; Page, Anne-Laure; Moriyon, Ignacio; Zuniga, Amaia; Conde, Raquel; Laku, Richard; MSF-OCA (2018-07)
    3. Objectives 3.1 Primary objective To estimate the diagnostic accuracy (sensitivity, specificity, positive and negative predicative values and likelihood ratios) of the modified RBT method and the rapid diagnostic test developed by the KIT tests performed (if commercially available) at Institute for Tropical Health (ITH), the University of Navarra, Pamplona, Spain for the diagnosis of brucellosis. Specimens collected in an endemic region (South Sudan) will be used and characterized at the ITH at the University of Navarra, Pamplona, Spain with undiluted RBT, SAT, Coombs test, Brucellacapt and when necessary an indirect ELISA used as the reference tests. 3.2 Secondary objectives • To assess the diagnostic accuracy (sensitivity, specificity, positive and negative predicative values and likelihood ratios) of the Rose Bengal test (Spinreact, Spain) at the study site. • To assess inter-user agreement of the RB test performed on site and at ITH. • To optimize the buffer used in the RBT using characterized sera available at ITH and evaluate the diagnostic performance of the modified method with serum dilution using specimens collected in this study. To date the buffer conditions are those used for diagnosis in cattle and they have not been optimized for diagnosis in humans. In fact, the conditions used in the Brucellacapt (i.e. a special buffer at pH 5.0) also render all antibodies agglutinating. Therefore, some simple modifications of the RBT conditions (i.e. pH and ionic strength) may improve the performance of RBT and produce a similarly simple but better test. • To estimate the diagnostic performance of an ‘in-house’ latex-agglutination test against Brucella-specific cytosoluble proteins. • To describe the clinical characteristics of brucellosis suspects and confirmed cases • To assess/identify risk factors for brucellosis in the study population
  • The perceptions and experiences of health and health seeking behaviour for the community living in the slum areas of Kamrangirchar and Hazaribag, Dhaka, Bangladesh: a qualitative study

    van der Heijden, Jeroen; Stringer, Beverly; Gray, Nell; Kalon, Stobdan; Dada, Martins; Shaheen, Aminur; Akhter, Sadika; Hussian, Enayet; Bishwash, Animesh; MSF-OCA (2018-07)
    Objectives This study aims to provide a better understanding of community perceptions toward health and health services in order to inform programme strategies: • Describe community and local-level perspectives and opinions on health care provision; • Document gaps, barriers and influences that impact access and acceptance of health care; • Contribute to best practice and development of health policy for this population
  • A prospective, randomized, controlled trial of negative-pressure wound therapy use in conflict-related extremity wounds

    Alga, Andreas; Bashaireh, Khaldoon; Wong, Sidney; Lundgren, Kalle; von Schreeb, Johan; MSF-OCA (2018-07)
    Extremity wounds and fractures constitute the majority of conflict-related traumatic injuries, both for civilians (1) and combatants (2). Conflict-related injuries often result in soft and boney tissue being contaminated with foreign material, generally leading to secondary infection (3,4). Negative-pressure wound therapy (NPWT) is widely used in the treatment of wounds and is considered to promote wound healing and prevent infectious complications. The technique involves the application of a wound dressing through which a negative pressure is applied. Any wound and tissue fluid is drawn away from the area and collected into a canister. Due to a plastic film overlaying the wound the risk of wound contamination is reduced. NPWT is supported for use in a range of surgical applications, including after or in between debridements as a bridge to definite closure of soft tissue wounds (5). The technique has previously been used in the treatment of acute conflict-related wounds with satisfactory results (6–8). Cochrane reviews of NPWT for the treatment of chronic wounds (9) and surgical wounds (10) were inconclusive due to the lack of suitably powered, high-quality trials. A recent systematic review of randomized, controlled trials (RCTs) of NPWT for the treatment of acute and chronic wounds concluded there is a lack of evidence and that good RCTs are needed (11). For the use in limb trauma, NPWT is considered suitable for complex soft tissue injuries (12). NPWT appears to be an effective and safe adjunctive treatment of high-energy combat wounds but existing results are retrospective and lack follow-up (13). The support of RCTs is needed to establish best treatment strategies. Summary of potential risks and benefits Both treatment methods (NPWT and conventional dressings) are well established and used in Jordan for the treatment of acute and chronic wounds. As neither of the two treatment modalities are known to be better in terms of outcome neither patient group may be regarded as receiving preferential treatment. NPWT is generally considered a safe treatment method. Potential benefits are shortened healing time and fewer infectious complications. Potential risks are pain, mainly associated with dressing changes (14) and bleeding, predominantly minor bleeding from granulation tissue (15). Conventional wound dressing has the potential benefit of being a safe treatment method used for many years. Since this method permits air into the wound there is a potential risk of contamination and the development of wound infection. Objectives We aim to evaluate the efficacy and safety of NPWT in the treatment of traumatic extremity wounds in a context associated with a high level of contamination and infection.
  • Malnutrition, morbidity and vaccination coverage in Bokoro District, Chad, 2016 (Final Survey) 1613C

    Lenglet, Annick; Vernier, Larissa; Monge, Susana; White, Kate; Sang, Sibylle; MSF-OCA (2018-07)
    3 OBJECTIVES 3.1 PRIMARY OBJECTIVES To estimate the impact of an integrated program targeted at preventing malnutrition on children under 5 years of age in Bokoro district. 3.2 SECONDARY OBJECTIVES - To describe the population in terms of age breakdown, sex, household composition etc. - To estimate overall mortality rate and under 5 mortality rate - To estimate the prevalence of severe and global acute malnutrition (SAM and GAM) in the under 5 year age group and in children between 6 and 23 months that are the specific target of MSF prevention activities; - To estimate the coverage of insecticide treated bednets in the community; - To estimate the coverage of soap and hygiene practices in the community - To estimate coverage of plumpydoz (nutritional food) in children between 6 months and 2 years of age and to investigate practices around plumpydoz.
  • Malnutrition, morbidity and vaccination coverage in Bokoro District, Chad, 2016 (Mid Term Survey).

    Lenglet, Annick; Monge, Susana; Ndumbi, Patricia; Nyarwangu, Justin; Hamdan, Musa; Cramond, Vanessa; Sang, Sibylle; MSF-OCA (2018-07)
    3 OBJECTIVES 3.1 PRIMARY OBJECTIVES To estimate the impact of an integrated program targeted at preventing malnutrition on children under 5 years of age in Bokoro district. 3.2 SECONDARY OBJECTIVES - To describe the population in terms of age breakdown, sex, household composition etc. - To estimate overall mortality rate and under 5 mortality rate - To estimate the prevalence of severe and global acute malnutrition (SAM and GAM) in the under 5 year age group and in children between 6 and 23 months that are the specific target of MSF prevention activities; - To estimate the coverage of insecticide treated bednets in the community; - To estimate the coverage of soap and hygiene practices in the community - To estimate coverage of plumpydoz (nutritional food) in children between 6 months and 2 years of age and to investigate practices around plumpydoz.
  • Exploring the experiences of returned Ebola Virus Disease workers from the United Kingdom

    Cooper, Jane; Falade, Bankole; Mannell, Jenevieve; MSF-OCA (2018-07)
    A brief summary of MSF EVD programmes & workers MSF has been running EVD programmes including Treatment Centres in affected countries since early 2014, and currently employs 325 international and around 4150 national staff . MSF protocols to deliver care and control transmission, and to ensure and monitor the health of workers, were available, based on experience in previous outbreaks over many years. In the latter part of 2014, other organisations and national governments established programmes in, and/or sent volunteer workers to, affected countries. In parallel, national protocols for the monitoring of returned workers, and the screening of travellers, have been established in many countries. MSF international workers have, to date, numbered some [insert] in total. Infection of MSF workers has been relatively rare, being reported in [insert] international workers, and [insert] national workers; [insert] of the latter have died. Most cases in national workers have been attributed to exposures in the community. No cases of infection due to secondary transmission from infected MSF international workers have been identified. [check]. To date, [insert] MSF international workers have returned to the UK; [insert] of these have undertaken more than one mission. No UK returnees have been infected [check] Overall aim: To describe and explore the experiences of UK EVD workers during the period following their return Specific objectives: 1. To explore experiences, perceptions, and views of interactions with family and friends 2. To explore experiences, perceptions, and views of interactions with the general public 3. To explore experiences, perceptions, and views of interactions with colleagues and managers in returning to work 4. To explore experiences, perceptions, and views of public opinion and media coverage 5. To explore experiences, perceptions, and views of policy implementation 6. To identify potential lessons, and areas for potential future research, relevant to the management of staff and programmes
  • Review of MSF-OCA surveillance and alert response in Freetown during the Ebola outbreak: lessons learned and challenges

    West, Kim; Greig, Jane; Lokuge, Kamalini; Caleo, Grazia; Stringer, Beverley; Korr, Gerit Solveig; MSF-OCA (2018-07)
    Aim: To reduce suffering, morbidity and mortality by containing and reducing the spread of Ebola Virus Disease (EVD), while preserving human dignity for the affected population in Sierra Leone. Purpose: To reduce and ultimately eliminate the transmission of EVD in a defined catchment population in Freetown. Objectives: • Provide epidemiological technical support to intensify surveillance, supervision of the alert response and enhanced case investigation in the defined area. • Assess and respond to current gaps in infection prevention and control, water and sanitation, and triage in health facilities within the defined area. • Assess community social mobilisation, health promotion, contact tracing and quarantine interventions in the defined area and respond to any gaps through advocacy towards the relevant pillar/organization and/or through direct MSF intervention. • Prioritise MSF and health staff safety & biosecurity at all times • Medical (non-Ebola) and humanitarian needs of the population are monitored, recorded, analysed and responded to through advocacy or MSF action.
  • Evaluating the effectiveness and burden of diabetes care in a complex humanitarian emergency setting in Mweso, North Kivu, Democratic Republic of the Congo (DRC), 2015

    Caleo, Grazia; Ngadjo, Cyril; Roberts, Bayard; Kitembo, Augustin Wika; Jobanputra, Kiran; Perel, Pablo; de la Croix, Jean; Sadique, Zia; de Wit, Marit; MSF-OCA (2018-07)
    Executive summary Background: Since 2008 Médecins Sans Frontières-Operational Centre Amsterdam (MSF-OCA) has been working in Mweso health zone, North Kivu, Democratic Republic of the Congo (DRC). In collaboration with the local Ministry of Health (MoH), MSF-OCA supports the Hospital in Mweso and 4 out of 23 Primary Health Care clinics. Mweso Hospital routinely treats diabetic patients presenting with acute complications and in need of treatment (insulin and/or oral treatment). Since 2011, this has been extended to the out-patient clinic, but without clinical guidance or standard operating procedures (SOP), nor specifically trained staff. The Mweso project reports increasing numbers of patients with diabetes and diabetes-related complications, and requested from MSF-OCA to implement a formal diabetes service to improve quality of care for Diabetics. Rationale: A new model of diabetes care was implemented by MSF-OCA in Mweso in March 2015. The model (Integrated Diabetic Clinic within an Outpatient Department (IDC-OPD)) is based on simplified context-adapted clinical guidelines, clinical SOPs, adapted patient counselling & support materials, medications from World Health Organization(WHO) Essential Medicines list, and one-off staff training by a Diabetologist. This represents an opportunity to evaluate and refine this model of diabetes care to support its application in comparable settings. Furthermore there is an opportunity to benchmark diabetes burden in the MSF Catchment area and measure its diabetes care coverage in the area. Overall aim: To evaluate IDC-OPD in Mweso health zone, North Kivu, DRC. The specific objectives are to examine: • The reach (coverage) of the diabetes service to the intended target population. • The effectiveness of IDC-OPD in improving diabetes outcomes (fasting blood glucose and complications) • Adoption / acceptance of IDC-OPD by staff and patients • Implementation of IDC-OPD in terms of consistency/fidelity, adaptation and costs • Maintenance of IDC-OPD in patients and programme over time.
  • Prevalence of depression, anxiety and posttraumatic stress related symptoms in the Kashmir Valley – a cross sectional study, 2015.

    Housen, Tambri; Shah, Showkat; Janes, Simon; Pintaldi, Govanni; Lenglet, Annick; Ariti, Cono; MSF-OCA (2018-07)
    Objectives 1.5 Primary objective To estimate prevalence of mental health related problems, specifically depression/anxiety and posttraumatic stress symptoms in the Kashmir Valley and to determine the accessibility to mental health services. 1.6 Specific objectives • Using validated screening tools determine the percentage of people with depression, anxiety and PTSD symptoms in Kashmir; • To correlate scores obtained on validated mental health screening tools with individual psychiatric evaluations using the mini international neuropsychiatric interview (MINI); • To explore local knowledge and perceptions of mental illness in Kashmir; • To determine the level of access to mental heath services across Kashmir; • To identify mental health service needs perceived by the Kashmiri community. 1.7 Goal To provide an updated insight into current mental health needs in Kashmir, which will help MSF to increase relevance and impact of current activities in Kashmir and to advocate for supportive programming and policy review.
  • Health and developmental outcomes of low-birth-weight infants born at the Centre de Référence d’Urgences Obstétricales (CRUO), Port-au-Prince, Haiti.

    Hillaire, Marjorie; Lenglet, Annick; Ariti, Cono; Ledger, Elizabeth; Reilly, Liam; Berthet, Marine; Faniyan, Olu; MSF-OCA (2018-07)
    Summary Title A prospective cohort study investigating health and developmental outcomes of low birth weight infants born at the Centre de Reference d’Urgences Obstretricales (CRUO), Port-au-Prince, Haiti. Primary objective: To describe and compare health and developmental outcomes between low birthweight (LBW) and normal weight infants up to 24 months post-partum, corrected for gestational age. Secondary objective To identify risk factors associated with negative health and developmental outcomes in LBW infants.
  • Mental health literacy of internally displaced Syrian young people and their parents in Syria: paving the way for mental health education and promotion in vulnerable communities.

    Hitchman, Eleanor; Slewa-Younan, Shameran; Cramond, Vanessa; White, Kate; Carrion-Martin, Isidro; Jorm, Anthony F.; MSF-OCA (2018-07)
    4. Objectives 4.1 Primary objective To determine levels of MHL relating to trauma related mental health disorders, namely posttraumatic stress disorder (PTSD) and depression among the displaced Syrian young people in northern Syria (see study population) . 4.2 Specific objectives 1. To estimate MHL relating to PTSD (and Depression) in a group of displaced Syrian young people (13-17 years old) and the parents of children (age 8-12 years old) pertaining to: a. Problem recognition (including “self-recognition”) b. Beliefs about the severity of the problem described and its prevalence in the target population c. Beliefs about causes and risk factors d. Beliefs about how best to support someone with PTSD/depression e. Beliefs about the helpfulness of specific treatments and treatment providers f. Beliefs about likely outcome with and without treatment g. Beliefs about possible barriers to treatment h. Stigma and perceived discrimination towards someone with PTSD/depression i. 2. To determine associations between specific aspects of MHL as outlined above, and individuals’ demographic characteristics (age, gender, religion, ethnicity, lengthen of displacement etc.) and symptom levels. 3. To estimate the prevalence of mental health distress (major depression, anxiety disorders or suicidality ) using the Self Reporting Questionnaire (SRQ-20) in care takers of children 8-12 years old; 4. To estimate the prevalence of constructs of intrusion, avoidance and arousal in children 8-17 years of age in the study population; 5. To estimate the prevalence of self-reported depression in children 8-17 years old. The categories specified in objective 1 above were chosen because they were considered to be the aspects of MHL most likely to be of interest in informing the determinants of mental health and quality of life in the proposed population. Objective 2 which seeks to examine the associations between specific aspects of MHL and individuals’ demographic characteristics and symptoms levels is important because associations of this kind can indicate specific targets for health promotion programs.
  • Predicting Visceral Leishmaniasis in HIV Infected Patients (PreLeisH)

    Griensven, JV; Diro, Ermias; MSF-OCA (2018-07)
    Aim To study the asymptomatic period preceding the onset of active VL in HIV‐infected individuals from VL endemic regions in Ethiopia as an avenue to develop an evidence‐based screen and treat strategy to prevent progression to active VL.Primary: 1. To estimate the prevalence of asymptomatic Leishmania infection . 2. To estimate the incidence rate of asymptomatic Leishmania infection. 3. To describe the evolution of Leishmania infection markers over time. 4. To estimate the incidence rate of active VL. 5. To identify risk factors associated with the development of active VL. 6. To translate these risk factors into a clinical prognostic tool to identify individuals at high risk to develop active VL within 12 months . Secondary: 1. To identify patterns in host immune markers that are associated with asymptomatic Leishmania infection. 2. To describe the evolution of host immune markers over time. 3. To identify patterns in host immune markers that are associated with treatment failure. 4. To identify patterns in host immune markers that are associated with VL relapse.
  • Morbidity, healthcare needs and barriers to access medical care amongst local and displaced populations in west Dar’a and Quneitra, Southern Syria.

    Homan, Tobias; Shoaib, Muhammad; de Rosa, Allan; Alfadel, Imad Aldin; Stein, Susan; Khalaileh, Fadi; Al-Khalouf, Nahed; Bil, Karla; MSF-OCA (2018-07)
    Objectives 2.1 Primary objective To determine the health care needs for local population and IDP’s in west Dar’a and Quneitra by estimating the prevalence of underlying morbidities, vaccination coverage and identifying barriers to access to health care, in order to obtain a baseline that can guide MSF and actor response. 2.2 Secondary objectives The relevance of subjects for the (secondary) objective(s) has been informed by insights from reports of, and explorative meetings with MSF and medical NGOs active in southern Syria (section 3.2.3). Of the secondary objectives identified, similar objectives are reflected in MSF-ERB approved protocols for surveys conducted in the region. We formulated the objectives (and related indicators on page 15) as much as possible on basis of these approved secondary objectives . I. To describe the socio-demographic characteristics of the surveyed population including age, gender and household characteristics. II. To estimate the prevalence of self-reported morbidities in previous two weeks, an estimate of the prevalence of non-communicable diseases, and the main reasons for requiring medical care. III. To estimate the vaccination coverage for key vaccine preventable diseases in children aged 6-59 months. IV. To characterise health care utilisation, the degree of access to healthcare for common morbidities in the population (health seeking behviour) and determine the most common barriers to access to health care. V. To estimate the global acute malnutrition [GAM] rate of in children aged 6-59 months. VI. To estimate the prevalence of conflict-related trauma experienced during the recall period. VII. To what extent maternal and reproductive health services are utilized by assessed crisis-affected women of 15-49 years of age in this area. VIII. To estimate the retrospective mortality and cause of mortality, over the past 6 months (since Ramadan 2017). IX. To better understand the configuration of the health system following the crisis, the characteristics of care-seeking and the quality of the services.

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