• Research Protocol - Inpatient signs and symptoms and factors associated with death among children aged ≤5 years admitted to two Ebola Management Centres in Sierra Leone, 2014: a retrospective cohort study

      Shah, Tejshri; Caleo, Grazia; Lokuge, Kamalini (2015-12-16)
      1. To describe the source case for children 2. To describe the viral load at presentation 3. To document the intervals between symptom onset and presentation for those who die and those who survive 4. To describe early symptoms of Ebola virus disease 5. To assess the association between risk factors and death
    • Research Protocol - Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study

      Shah, Tejshri; Greig, Jane; van der Plas, LM; Achar, J; Caleo, Grazia; Squire, James Sylvester; Turay, AS; Joshy, G; D’Este, C; Banks, E; et al. (2016-07)
      Background Médecins Sans Frontières (MSF) opened Ebola management centres (EMCs) in Sierra Leone in Kailahun in June, 2014, and Bo in September, 2014. Case fatality in the west African Ebola virus disease epidemic has been highest in children younger than 5 years. Clinical data on outcomes can provide important evidence to guide future management. However, such data on children are scarce and disaggregated clinical data across all ages in this epidemic have focussed on symptoms reported on arrival at treatment facilities, rather than symptoms and signs observed during admission. We aimed to describe the clinical characteristics of children aged 5 years and younger admitted to the MSF EMCs in Bo and Kailahun, and any associations between these characteristics and mortality. Methods In a retrospective cohort study, we included data from children aged 5 years and younger with laboratory-confirmed Ebola virus disease admitted to EMCs between June and December, 2014. We described epidemiological, demographic, and clinical characteristics and viral load (measured using Ebola virus cycle thresholds [Ct]), and assessed their association with death using Cox regression modelling. Findings We included 91 children in analysis; 52 died (57·1%). Case fatality was higher in children aged less than 2 years (76·5% [26/34]) than those aged 2–5 years (45·6% [26/57]; adjusted HR 3·5 [95% CI 1·5–8·5]) and in those with high (Ct<25) versus low (Ct≥25) viral load (81·8% [18/22] vs 45·9% [28/61], respectively; adjusted HR 9·2 [95% CI 3·8–22·5]). Symptoms observed during admission included: weakness 74·7% (68); fever 70·8% (63/89); distress 63·7% (58); loss of appetite 60·4% (55); diarrhoea 59·3% (54); and cough 52·7% (48). At admission, 25% (19/76) of children were afebrile. Signs significantly associated with death were fever, vomiting, and diarrhoea. Hiccups, bleeding, and confusion were observed only in children who died. Interpretation This description of the clinical features of Ebola virus disease over the duration of illness in children aged 5 years and younger shows symptoms associated with death and a high prevalence of distress, with implications for clinical management. Collection and analysis of age-specific data on Ebola is very important to ensure that the specific vulnerabilities of children are addressed.
    • Research Protocol - Mortality Rates above Emergency Threshold in Population Affected by Conflict in North Kivu, Democratic Republic of Congo, July 2012–April 2013

      Carrión Martín, A I; Bil, K; Salumu, P; Baabo, D; Singh, J; Kik, C; Lenglet, A; MSF Amsterdam; Médecin Inspecteur Provinciale, Goma, North Kivu, Democratic Republic of Congo; Zone de Santé, Walikale, North Kivu, Democratic Republic of Congo (2014-09-18)
      The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF) returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs), access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012–April 2013). In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR) was of 1.4/10,000 persons/day (CI95%: 1.2–1.7) and the under-five- mortality rate (U5MR) of 1.9/10,000 persons per day (CI95%: 1.3–2.5). The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4–42.9). Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2–75.4). Non Food Items (NFI) ownership was low: 69.0% (CI95%: 53.1–79.7) at least one 10 liter jerry can, 30.1% (CI95%: 24.3–36.5) of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period.
    • Research Protocol - Post-kala-azar Dermal Leishmaniasis (PKDL): a prospective observational study of the effectiveness and safety of an ambulatory short course treatment with AmBisome* 15 mg/kg total dose

      Ritmeijer, Koert; Kumar Das, Asish; Ahmed, Be-Nazir; den Boer, Margriet; Almeida, Patrick; Verputten, Meggy; MSF-Holland, Amsterdam, The Netherlands; MSF-Holland, Fulbaria, Bangladesh; CDC, (DGHS); MSF-Holland, Amsterdam, The Netherlands; MSF-Holland, Dhaka, Bangladesh; MSF-Holland, Amsterdam, The Netherlands (2014-06)
      General objective To evaluate the effectiveness and safety of PKDL treatment with AmBisome 15 mg/kg total dose, given over 15 days in 5 infusions (twice weekly) of 3mg/kg on an ambulatory basis in a primary health care setting. Primary objective: to evaluate the effectiveness of AmBisome 15 mg/kg total dose at 12 M Secondary objective: • Evaluate the safety of AmBisome 3mg/kg x 5 infusions (twice weekly) (15 mg/kg total dose) • Evaluate the occurrence of hypokalaemia • Evaluate at which point in time lesions start to respond to treatment.
    • Research Protocol - 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, Giovanni; Lenglet, Annick; Ariti, Cono; MSF OCA, New Delhi, India; Kashmir University; MSF OCA, New Delhi, India; MSF OCA, Amsterdam, Netherlands; MSF OCA, Amsterdam, Netherlands;Manson Unit, MSF UK, London, UK (2015-07)
      Primary Objective: To estimate prevalence of mental health related problems, specifically depression/anxiety and posttraumatic stress symptoms in Kashmir and to determine the accessibility to mental health services. Study Design: Mixed methods research design incorporating cross-sectional household survey, clinical psychiatric interviews, key informant interviews and focus group discussions. Inclusion Criteria: Participants will be included if they can meet the following criteria: • 18 years of age or older. • Able to provide informed consent. Exclusion Criteria: Participants will be excluded from the study if they meet the following criteria: • Unable to provide verbal informed consent. • Choose to withdraw their consent. Intervention: The survey will be conducted in the Kashmiri language by interview enumeration. A sub-sample of the survey population will undergo a mini-international neuropsychiatric interview (MINI) by a trained interviewer. Key informant interviews and focus group discussions will occur concurrently with the household survey. Sample Size: 4800 probability sampled households from 10 districts, 12 households from each village. A sub-sample of 200 individuals who test positive on validated screening tests will be convenience sampled for formal psychiatric interview (MINI). Two focus group discussions will be held in each district and will be comprised of 8-10 convenience sampled participants. Primary Outcome Measure: • Point Prevalence of depression/anxiety and posttraumatic stress symptoms. • Qualitative data on access to mental health services and perceived needs.
    • Research Protocol - Secondary prophylaxis of visceral leishmaniasis relapses in HIV co-infected patients using pentamidine as a prophylactic agent: a prospective cohort study

      Diro, Ermias; van Griensven, Johan; Hailu, Asrat; Ritmeijer, Koert; Gryseels, Bruno; University of Gondar, Gondar, Ethiopia; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium; Addis Ababa University, Addis Ababa, Ethiopia; Médecins Sans Frontières, Amsterdam, The Netherlands; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium (2014-10)
    • Research Protocol - The Impact of a Tick-Sheet in Improving Interpretation Accuracy of Chest Radiographs by Non-Specialists in an HIV positive cohort

      Kosack, Cara; Bonnet, Maryline; Spijker, Saskia; Mesic, Anita; Joekes, Elizabeth; Médecins Sans Frontières – International; Epicentre; Médecins Sans Frontières – International; Médecins Sans Frontières – Holland; LSTM, UK (2014-06)
      Primary objective of this study: 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 non-specialists, in an HIV-positive cohort. Secondary objective: To determine whether the application of a tick-sheet reduces the inter-reader variability of CXR interpretation in a group.
    • Research Protocol - The practice of medical humanitarian emergency: ethnography of practitioners’ response to nutritional crisis

      Stellmach, Darryl; Ulijaszek, Stanley; Mol, Annemarie; Stringer, Beverley; University of Oxford, Oxford, UK; University of Oxford, Oxford, UK; University of Amsterdam, Amsterdam, The Netherlands; Médecins Sans Frontières UK, London, UK (2014-07)
      Overall Aim: To describe and understand the human and technological factors that contribute to the constitution of emergency as a named and actionable entity in the context of medical humanitarianism. Primary Objective: To describe how individual and institutional attitudes, tools, discretion and practices influence identification and response to emergency. Secondary Objective: To document ambiguities, uncertainties or structural barriers that impede the identification of and response to emergency.
    • Research Protocol - Understanding how communities interact with the Ebola intervention as it unfolds and the subsequent value of specific control measures for a sustained success in the response in Sierra Leone: a qualitative study

      Gray, Nell; Stringer, Beverley; Broeder, Rob; Jephcott, Freya; Perache, Andre Heller; Bark, Gina; Kremer, Ronald; MSF UK, London; MSF UK, London; MSF OCA, Sierra Leone; MSF OCA, Sierra Leone; MSF UK, London; MSF OCA, Amsterdam; MSF OCA, Amsterdam (2015-07-02)
      This study aims to provide a better understanding of community interaction with the Ebola response in Sierra Leone in order to inform programme strategies: • Describe community and local-level perspectives and attitudes toward the measures taken to control the Ebola outbreak, with consideration of how such measures may have been integrated into personal narratives over time; • Document gaps, barriers and influences that impact control measures; • Consider the subsequent value of control measures used to inform an effective future outbreak response.
    • Research Protocol - Uptake of household disinfection kits as an additional measure in response to a cholera outbreak in urban areas of Haiti

      Gartley, M; Valeh, Parastou; de Lange, R; DiCarlo, S; Viscusi, A; Lenglet, A; MSF Amsterdam (2013-12)
      Médecins Sans Frontières-Operational Centre Amsterdam piloted the distribution of household disinfection kits (HDKs) and health promotion sessions for cholera prevention in households of patients admitted to their cholera treatment centres in Carrefour, Port au Prince, Haiti, between December 2010 and February 2011. We conducted a follow-up survey with 208 recipient households to determine the uptake and use of the kits and understanding of the health promotion messages. In 61% of surveyed households, a caregiver had been the recipient of the HDK and 57.7% of households had received the HDKs after the discharge of the patient. Among surveyed households, 97.6% stated they had used the contents of the HDK after receiving it, with 75% of these reporting using five or more items, with the two most popular items being chlorine and soap. A significant (p < 0.05) increase in self-reported use items in the HDK was observed in households that received kits after 24 January 2011 when the education messages were strengthened. To our knowledge, this is the first time it has been demonstrated that during a large-scale cholera outbreak, the distribution of simple kits, with readily available cleaning products and materials, combined with health promotion is easy, feasible, and valued by the target population.
    • Retrospective mortality and baseline health survey in Kutupalong and Balukhali settlement camps, Bangladesh

      Siddiqui, Ruby; White, Kate; Guzek, John; MSF-OCA (2018-07)
      2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events 2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events
    • Retrospective mortality and baseline health survey in Ofua village, Rhino settlement camp, Uganda

      Siddiqui, M Ruby; Cramond, Vanessa; Barre, Ibrahim; Johnson, Derek; MSF-OCA (2018-07)
      OBJECTIVES 2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To estimate the size of the population in Rhino (Ofua) settlement camp  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenAfriVac, DPT-Hib-HepB (Pentavalent) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events  To determine the coverage of Long-Lasting Insecticide Treated bedNets (LLITNs)
    • Retrospective mortality and baseline health survey in Palorinya settlement camp, Uganda

      Siddiqui, M Ruby; Cramond, Vanessa; Goldberg, Jacob; Guzek, John; MSF-OCA (2018-07)
      2. OBJECTIVES 2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To estimate the size of the population in Palorinya settlement camp  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenAfriVac, DPT-Hib-HepB (Pentavalent) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events  To determine the coverage of Long-Lasting Insecticide Treated bedNets (LLITNs)
    • 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;
    • Retrospective population-based mortality survey in an urban and rural area of Sierra Leone, 2015

      Caleo, Grazia; Kardamanidis, Katina; Broeder, Rob; Belava, Jaroslava; Kremer, Ronald; Lokuge, Kamalini; Greig, Jane; Turay; Saffa, Gbessay; MSF-OCA (2018-07)
      2. Objectives 2.1. Primary objectives The Primary objective of the survey is to:  Estimate mortality in a sample of the population in the urban and rural area of Bo District from the approximate start of the Ebola outbreak in Sierra Leone (mid May 2014) until the day of the survey. 2.2. Secondary objectives  Estimate overall and cause-specific mortality (EVD and non-EVD) in children under the age of 5 years, and the population aged 5 years and older within the study area, with particular attention to the period prior to the MSF Ebola Management Centre (EMC) opening in Bo district (19 September 2014) and the period during which it was receiving cases from the district (last confirmed case exited 26 January 2015);  Estimate overall and cause-specific mortality (EVD and non-EVD) in quarantined and non-quarantined households; and contact-traced and non-contact-traced households;  Describe health seeking behaviour in terms of whether health care was sought, where health care was sought and whether access to health care was possible.
    • Review of maternal mortality cases in MSF-OCA projects 2015 (a capture-recapture study)

      Price, Debbie; Lenglet, Annick; Thoulass, Janine; Willrich, Niklas; MSF-OCA (2018-07)
      Aim To identify the best method to monitor maternal mortality in MSF-OCA facilities prospectively. Objectives/Research questions  Evaluate the current surveillance system for maternal mortality in MSF-OCA facilities  Estimate maternal mortality in MSF-OCA facilities for 2015  Identify contributing factors to maternal mortality in MSF-OCA facilities for 2015
    • 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.
    • Risk factors for diagnosed Noma in North West Nigeria, 2017

      Lenglet, Annick; Farley, Elise; Trienekens, Suzan; Amirtharajah, Mohana; Bil, Karla; van der Kam, Saskia; Jiya, Nma M.; Huisman, Geke; Adetunji, Adeniyi Semiyu; Stringer, Beverley; et al. (2018-07)
      Background Noma is an orofacial gangrene that rapidly eats away at the hard and soft tissue as well as the bones in the face. Noma has a 90% mortality rate, and the disease affects mostly children under the age of 5. Little is known about Noma as the majority of cases live in underserved, difficult to reach locations. MSF runs projects at the Noma Children’s Hospital in Sokoto, northern Nigeria and currently assists with surgical interventions for the patients who have survived and sought care at the hospital. Community outreach and active case finding are also taking place. These projects place MSF in a unique position to study Noma, and to add to the scant body of knowledge around the disease. Aims and objectives Aim To identify risk factors for Noma in north west Nigeria in terms of epidemiological (demographic characteristics, medical history), socio-economic-behavioural aspects and access to health care in order to better guide existing prevention strategies. Specific objectives 1. To understand concepts and perceptions of Noma within the population of northwestern Nigeria, specifically those affected (caretakers of Noma cases) by the disease, and controls matching these cases. To describe the epidemiological profile of all cases of Noma that have been treated at the MSF Noma Children’s Hospital from August 2015 until June 2016; 2. To describe the current Noma patient’s clinical history before the onset of the disease, the start of the disease and the care/treatment sought as well as the impact of Noma on the patient; 3. To assess Noma risk factors by comparing cases enrolled at the Noma Children’s Hospital and controls matched to cases by sex, age, and village of residence; All of these objectives are in order to assess if there are intervention opportunities in the unique Nigerian setting that could prevent further Noma case development. Methods 1) Qualitative phase: focus groups will take place with care takers (guardians or parents) of cases as well as key informant interviews with health care workers to better understand the local concepts, vocabulary and expressions used to describe Noma in this part of Nigeria. 2) Descriptive epidemiology: description of all available medical, nutritional and mental health data associated with the Noma patients operated on at the Noma Children’s Hospital over the last year. 3) Case control study: assessing risk factors for Noma using care takers of cases recruited from the Noma Children’s Hospital and care takers of controls that are recruited from cases village of residence and matched by age and sex. Outcomes • Initiate the MSF operational research agenda around Noma in Nigeria; • Improved understanding of local beliefs, traditions and language used to describe Noma; • Improved understanding of Noma patients at the Sokoto Children’s hospital; • Identification of preventable risk factors for Noma development in our patients; • Integration of information obtained into outreach programming, improved community engagements, options for preventative campaigns and overall improved clinical and mental health care of Noma patients and caretakers in the MSF project.  
    • Secondary prophylaxis of visceral leishmaniasis relapses in HIV co-infected patients using pentamidine as a prophylactic agent: a prospective cohort study

      Diro, Ermias; Griensven, Johan van; Woldegebreal, Teklu; Belew, Zewdu; Taye, Melese; Yifru, Sisay; Davidson, Robert N.; Balasegaram, Manica; Lynen, Lut; Boelaert, Marleen; et al. (2018-07)
      2.1 OBJECTIVES 2.1.1 General objective: To document the effectiveness, safety and feasibility of monthly PM secondary prophylaxis (PSP) in VL/HIV co-infected patients that have documented parasite clearance after VL treatment when used for prevention of VL relapse. 2.1.2 Specific objectives of the primary study period 2.1.2.1 Primary objectives In VL/HIV co-infected patients that have documented parasite clearance after VL treatment: - to assess the effectiveness of PSP in terms of preventing relapse and death; - to assess the safety of PSP in terms of drug-related serious adverse events or permanent drug discontinuations due to adverse events; - to assess the feasibility of PSP in terms of number of patients compliant to therapy during the first year of monthly PM secondary prophylaxis. 2.1.2.2 Secondary objectives; In VL/HIV co-infected patients that have documented parasite clearance after VL treatment: - to assess the safety of PSP in terms of: - drug-related non-serious adverse events - serious adverse events (drug-related or not) - to assess the feasibility of PSP in terms of: - number of treatment interruptions/discontinuations, - number of therapeutic interventions needed to treat adverse drug reactions