• Effectiveness of nutritional supplementation (ready-to-use therapeutic food and multi micronutrient) in preventing malnutrition in children 6-59 months with infection (malaria, pneumonia, diarrhoea) in Uganda

      Núria Salse; Núria Salse; Todd Swarthout; Kasujja Francis Xavier; Akiko Matsumoto; Christine Zahm; Kisambu James; Otelu Edyegu Grace; Pedro Pablo Palma; Veronique De Clerck; et al. (MSF OCA, 2013-09)
    • Emergency response to Typhoon Haiyan

      Curtis, David; Allie, Marie-Pierre Dr (2015-03-06)
      The Intersectional Philippines MSF Typhoon Haiyan Emergency Response review was requested by the Executive Committee of MSF. It was designed to examine the operational choices of each Operational Centre, the perceived cost disparity, the role of the MSF regional offices in the emergency and the external perception regarding MSF’s added value in the response. The review took place during August and November 2014. Overall the response by MSF to Typhoon Haiyan was well perceived by all involved. The response was timely compared to other actors, but the first MSF consultations were only done six days after the emergency and MSF’s surgical services commenced only after two weeks. The very low surgical activities done by OCB and OCBA raised the question of pertinence of the decision to send and setup an OT, especially as they were not functioning until two weeks after the typhoon. The presence of five OCs allowed for a good geographical coverage which was appreciated by the authorities and it allowed for a good contextual understanding and provision of a wide range of assistance. There was a cost disparity regarding the different operational choices and strategies which resulted in a wide difference between budgets. The MSF response was perceived as having had an added value and played an important role in the overall response, especially regarding the input provided by MSF as part of the foreign medical teams. The main obstacle remains the difficulty of access in natural disasters. From an MSF perspective the issue of supply remains a constraint, even though this doesn’t seem to be the case for OCB. How many resources are allocated towards managing supply in an emergency is still an issue for some OCs.
    • Enquête Connaissances Attitudes Pratiques (CAP) sur les moustiquaires dans la population de la préfecture de Kouroussa, Région de Kankan ; Guinée

      Molima, Gustave; Genin, Thibaud; Ngwa, wilfred; Adjaho, Ismaël; Haba, Benoit; Camara, Alioune; Camara, Denka; MSF OCB (MSF, 2018-06)
    • Enquête de couverture vaccinale multi antigénique Préfecture de Kouroussa

      Ngwa, W; Mupenda, J; Haba, B; Nanan-N'Zeth, K; Bachy, C; Pineda, S (2019-06-25)
      Objectif général Estimer la couverture vaccinale contre la rougeole chez les enfants âgés de 6 mois à 59 mois après la campagne de vaccination de masse appuyée par MSF au mois de décembre 2018 dans la Préfecture de Kouroussa. Décrire la couverture vaccinale par groupe d'âge des antigènes inclus dans le programme national de vaccination du PEV chez les enfants âgées de 6 semaines à 59 mois [BCG, VPO, DTC-Hib-HepB, et fièvre jaune]. Objectifs spécifiques  Estimer le nombre de doses reçues par enfant;  Décrire les raisons de non vaccination;  Décrire les moyens utilisés par la population pour s'informer de la campagne de vaccination. Design Il s’agit d’une enquête transversale en population dans la préfecture de Kouroussa, avec sondage aléatoire en grappe à deux degrés. Population cible La population cible était constituée des enfants de moins de 59 mois résidant dans la Préfecture de Kouroussa. Résultats L’enquête de couverture vaccinale s’est déroulée du 8 au 18 février 2019 dans les 12 sous-préfectures de Kouroussa. Au total 439 ménages et 1.340 enfants âgés de 0 à 59 mois ont été inclus dans l’enquête. Le pourcentage de rétention de la carte de vaccination est faible: 61,6% [95% IC 54,5 – 68,7] pour l’ensemble de l’échantillon. La plupart de l’échantillon est constitué d’enfants de plus de 23 mois [64%]. Le ratio masculin/féminin est de 1,0 Rougeole: couverture vaccinale pour les enfants de 9 mois à 59 mois est de 94,1% [IC=91,5 – 96,6]. Par tranche d’âge, le groupe de 9 mois à 11 mois, est le seul dont la couverture est inférieure à 90%, mais restée supérieure à 85%. Parmi les enfants entre 12 et 23 mois la couverture est 93,5% [IC=89,2 – 97,9]. Les taux de couverture vaccinale, pour les autres différents antigènes2: après analyse, il a été observé que les résultats de la couverture vaccinale [basés sur la déclaration de la mère] chez les enfants âgées de plus de 23 mois risquaient être fortement affectés par le biais de la désirabilité sociale. Par conséquent, les résultats sont présentés comme suit pour BCG, Polio, Penta et Fièvre jaune:  Enfants ≤ 23 mois : couverture vaccinale basée sur la carte de vaccination et les déclarations des mères  Enfants ≥ 24 mois : Couverture vaccinale basée seulement sur la carte de vaccination Parmi les enfants entre 12 et 23 mois, 93% ont reçu une vaccination BCG. Pour Polio et Penta, la première dose de chaque vaccin a été administrée respectivement à plus de 97% et 93% des enfants. Ce taux recule pour n’atteindre que 94% pour la deuxième dose de Polio et 90% pour Penta et entre 91% et 88% pour la troisième dose respectivement. Par rapport à la vaccination contre la fièvre jaune, la couverture est 67% pour les enfants entre 9 mois et 11 mois et 88% pour les enfants entre 12 mois et 23 mois. Chez les enfants âgés de 23 mois, la couverture vaccinale ne prenant en compte que les cartes de vaccination varie de 38% pour la première dose de polio / penta et de 34% pour la troisième dose, 41% pour le BCG et 32% pour la fièvre jaune. Les principales raisons de non-vaccination sont regroupées comme Manque d’opportunité [36,5%], Obstacles [25,9%] et le manque de motivation [20,4%]. Les relais communautaires étaient la source principale d’information [54%] sur la campagne de vaccination de masse contre la rougeole menée par MSF en décembre 2018 Conclusions 1. PEV assez performant. 2. Couverture vaccinale des enfants de 12 à 23 mois très satisfaisante pour toutes les vaccinations [> 85%]. 3. Haut pourcentage d’enfants entre 12 et 23 mois complètement vaccinés [77,9% CI 95% : 71,2 – 84,6] 4. Faible rétention de la carte de vaccination et / ou la carte de vaccination non mise à jour. [souvent plusieurs cartes de vaccination pour le même enfant] 5. Les principaux motifs de non-vaccination sont liés à sont liés au manque d'opportunités [absence/voyage des enfants/parents] et d'obstacles [pas de poste de santé] 6. La principale source d'information sur la campagne de vaccination contre la rougeole menée en décembre 2018 était les relais communautaires [54%] 7. La couverture vaccinale contre la rougeole globale est de 94,1% [IC=91,5 – 96,6] et reste supérieure à 90% dans tous les groupes d’âge, à l’exception des enfants entre 9 et 11 mois.
    • Enquête de mortalité infanto-juvénile et accès aux soins dans la Commune de Matam, Conakry, Guinée, 2009

      Müller, Yolanda; Medecins Sans Fronteres, Geneva, Switzerland; Epicentre, Paris, France (2009-08)
    • Evaluation of NCD service integrated into a general OPD and HIV service in Matsapha, Eswatini, 2017

      Ansbro, Eimhin; Meyer, Inga; Okello, Velephi; Verdecchia, Maria; Keus, Kees; Piening, Turid; Sadique, Zia; Roberts, Bayard; Perel, Pablo; Jobanputra, Kiran; et al. (2018-09)
      Background: Swaziland faces a growing noncommunicable disease (NCD) burden alongside HIV and TB epidemics. MSF provided primary care services, HIV and TB programmes at Matsapha MOH comprehensive clinic from 2011 to 2018. With MOH collaboration, MSF integrated NCD care into general outpatient (OPD), HIV and TB services in April 2016. A retrospective analysis of routine clinical and programmatic data was undertaken to examine programme processes, effectiveness and costs in order to strengthen the service, facilitate handover and inform MSF and MOH policy and scale-up. The specific objectives were to: 1) describe the care model; 2) examine its effectiveness; 3) examine predictors of NCD treatment outcomes, including HIV status; and 4) determine incremental total and unit service costs. Methods: We undertook a retrospective evaluation of routine data from Matsapha Comprehensive Care Clinic, located outside Manzini, Eswatini’s largest city. This comprised: care model description; routine cohort data analysis to investigate effectiveness of care and predictors of reaching clinical targets; and incremental costing analysis. Enrolment criteria included: a diagnosis of established cardiovascular disease (CVD), hypertension, diabetes mellitus (DM) types 1 or 2, chronic respiratory disease; and committing to regular attendance. Routine clinical data of adults aged 18 or over, enrolled from July 2016 to July 2017, were analysed using descriptive statistics and logistic regression modelling. A costing analysis from the providers’ perspective utilised routine accounting, service and consumption data. Results: Model of care description: We implemented: staff training; locally adapted protocols; chronic care files; a revised appointment system and patient flow; and a new database. Doctors reviewed patients at first visit, and saw complex or unstable patients monthly, resulting in significant workload. Nurses reviewed stable patients three-monthly; patients requiring treatment initiation/adjustment, ad hoc blood testing or external referral were referred back to doctors. Thus, task sharing to nurses did not occur as intended. Specific health literacy, adherence support groups or lay counsellor involvement were lacking. Integrating NCD care resulted in longer consultation times. Repeated medication stock outs occurred despite MSF’s efforts to support the MOH supply chain. Routine cohort data analysis: Of 895 enrolled patients, mean age was 55 years (IQR 5.3 to 10.6); 66% were women, of whom 54.6% were obese. Mean follow-up was 8 months; 16.3% defaulted during the study period. The most common diagnoses at enrolment were: hypertension (85.7%) and DM type 2 (37.4%), asthma (3.8%) and DM type 1 (1.2%). 3 patients had known CVD; none had known chronic obstructive pulmonary disease. At last visit, 60.4% (n=608) of hypertensive patients and 63.3% (n=289) of diabetics were at target. Obesity and HIV positivity were weakly associated with an increased risk of uncontrolled hypertension. Descriptive costing analysis: Total 2016 incremental financial costs were: INT$437,228. The principle costs drivers were human resources (61% of total) and drugs (18%; insulin accounting for a quarter). Per patient per year (PPPY) incremental costs (INT$ 448.52) were similar to those reported for chronic HIV programmes. Conclusions and Lessons Learned: NCD care can be integrated into a HIV department and OPD setting in an MSFsupported primary care centre by utilising pre-existing structures, and can achieve acceptable intermediate clinical outcomes and retention rates at a cost that is similar to HIV programmes. The current model of NCD care is complex and time consuming, resulting in significant doctor workload. Streamlined, algorithm-driven protocols and work with the local government to extend prescribing rights for NCD medications to nurses may facilitate task sharing and decentralisation of care. Drug supply chain strengthening is required and advocacy around drug prices could reduce programme costs. Inclusion of specific treatment support and adherence counselling, learning lessons from HIV and TB care, is also essential to integrating NCD care into pre-existing services.
    • Evaluation of two emergency interventions: outbreak of malaria and epidemic of measles, DRC

      Alena Koscalova; Marta Iscla; Médecins Sans Frontiéres (2014-11-18)
      This report sets out the results of the evaluation of two emergency interventions: outbreak of malaria and measles epidemic, carried out by OCG in Orientale Province of the Democratic Republic of the Congo between June 2012 and July 2013. It is a retrospective evaluation that was done between March and May 2014, with the methodology based mainly on a review of documents and interviews with resource persons. Its objective was to capitalise on the lessons learned so as to improve preparation and response capacity for future epidemics in similar situations. During the malaria outbreak, MSF led a four-month emergency intervention (28 June - 25 October 2012) targeting some 380 000 persons in the four health zones. In all, 58 761 cases of simple malaria were treated by the ambulatory units, and 3 537 cases of severe malaria were treated in four hospitalization units. In addition, 6 886 persons benefited from the "Test & Treat" strategy, 3 236 of whom (47%) tested positive and received ACT treatment. To respond to the measles epidemic, MSF intervened for nine months (November 2012 - July 2013) and covered some 741 000 persons in the seven health zones. In all, 26 804 cases of simple measles and 4 114 cases of complications were treated by MSF. In addition, 189 067 children between the ages of 6 months and 15 years were vaccinated against measles, with coverage ranging, according to surveys, from 87% to 97%.
    • Evaluation Report on the MSF Response to Displacement in Open Settings

      Koscalova, Alena; Lucchi, Elena; Vienna Evaluation Unit (2010-06)
    • Gender and Sanitation Tool for Displaced Populations

      WatSan Working Group; Medecins sans Frontieres (2014-01-10)
      This tool is meant to be used in the first and second stage of an emergency response where there is no time to implement a comprehensive consultation and participation process. The tool will help you to decide rapidly what and where sanitation facilities need to be built based on what women (but not exclusively), need with a minimum of effort or specialized expertise required. It is assumed that general WatSan needs are already assessed at this point.