Recent Submissions

  • Challenges associated with providing diabetes care in humanitarian settings

    Boulle, P; Kehlenbrink, S; Smith, J; Beran, D; Jobanputra, K (Elsevier, 2019-03-13)
    The humanitarian health landscape is gradually changing, partly as a result of the shift in global epidemiological trends and the rise of non-communicable diseases, including diabetes. Humanitarian actors are progressively incorporating care for diabetes into emergency medical response, but challenges abound. This Series paper discusses contemporary practical challenges associated with diabetes care in humanitarian contexts in low-income and middle-income countries, using the six building blocks of health systems described by WHO (information and research, service delivery, health workforce, medical products and technologies, governance, and financing) as a framework. Challenges include the scarcity of evidence on the management of diabetes and clinical guidelines adapted to humanitarian contexts; unavailability of core indicators for surveillance and monitoring systems; and restricted access to the medicines and diagnostics necessary for adequate clinical care. Policy and system frameworks do not routinely include diabetes and little funding is allocated for diabetes care in humanitarian crises. Humanitarian organisations are increasingly gaining experience delivering diabetes care, and interagency collaboration to coordinate, improve data collection, and analyse available programmes is in progress. However, the needs around all six WHO health system building blocks are immense, and much work needs to be done to improve diabetes care for crisis-affected populations.
  • The burden of diabetes and use of diabetes care in humanitarian crises in low-income and middle-income countries

    Kehlenbrink, S; Smith, J; Ansbro, E; Fuhr, D; Cheung, A; Ratnayake, R; Boulle, P; Jobanputra, K; Perel, P; Roberts, B (Elsevier, 2019-03-13)
    Human suffering as a result of natural disasters or conflict includes death and disability from non-communicable diseases, including diabetes, which have largely been neglected in humanitarian crises. The objectives of this Series paper were to examine the evidence on the burden of diabetes, use of health services, and access to care for people with diabetes among populations affected by humanitarian crises in low-income and middle-income countries, and to identify research gaps for future studies. We reviewed the scientific literature on this topic published between 1992 and 2018. The results emphasise that the burden of diabetes in humanitarian settings is not being captured, clinical guidance is insufficient, and diabetes is not being adequately addressed. Crisis-affected populations with diabetes face enormous constraints accessing care, mainly because of high medical costs. Further research is needed to characterise the epidemiology of diabetes in humanitarian settings and to develop simplified, cost-effective models of care to improve the delivery of diabetes care during humanitarian crises.
  • Access to Care for Non-Communicable Diseases in Mosul, Iraq Between 2014 and 2017: A Rapid Qualitative Study.

    Baxter, LM; Eldin, MS; Al Mohammed, A; Saim, M; Checchi, F (BioMed Central, 2018-12-29)
    During June 2014 to April 2017, the population of Mosul, Iraq lived in a state of increasing isolation from the rest of Iraq due to the city's occupation by the Islamic State group. As part of a study to develop a generalisable method for estimating the excess burden of non-communicable diseases (NCDs) in conflict-affected settings, in April-May 2017 we conducted a brief qualitative study of self-reported care for NCDs among 15 adult patients who had fled Mosul and presented to Médecins Sans Frontières clinics in the Kurdistan region with hypertension and/or diabetes. Participants reported consistent barriers to NCD care during the so-called Islamic State period, including drug shortages, insecurity and inability to afford privately sold medication. Coping strategies included drug rationing. By 2016, all patients had completely or partially lost access to care. Though limited, this study suggests a profound effect of the conflict on NCD burden.
  • Prevalence of non-communicable diseases and access to care among non-camp Syrian refugees in northern Jordan

    Rehr, M; Shoaib, M; Ellithy, S; Okour, S; Ariti, C; Ait-Bouziad, I; van den Bosch, P; Deprade, A; Altarawneh, M; Shafei, A; Gabashneh, S; Lenglet, A (BioMed Central, 2018-07-11)
    Tackling the high non-communicable disease (NCD) burden among Syrian refugees poses a challenge to humanitarian actors and host countries. Current response priorities are the identification and integration of key interventions for NCD care into humanitarian programs as well as sustainable financing. To provide evidence for effective NCD intervention planning, we conducted a cross-sectional survey among non-camp Syrian refugees in northern Jordan to investigate the burden and determinants for high NCDs prevalence and NCD multi-morbidities and assess the access to NCD care.
  • Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors

    Subramanian, S; Gakunga, R; Kibachio, J; Gathecha, G; Edwards, P; Ogola, E; Yonga, G; Busakhala, N; Munyoro, E; Chakaya, J; Ngugi, N; Mwangi, N; Von Rege, D; Wangari, LM; Wata, D; Makori, R; Mwangi, J; Mwanda, W (Public Library of Science, 2018-01-05)
    The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services.
  • Global Burden of Rheumatic Heart Disease

    Rossi, G (Massachusetts Medical Society, 2018-01-04)
  • Cardiovascular Disease Risk and Prevention Amongst Syrian Refugees: Mixed Methods Study of Médecins Sans Frontières Programme in Jordan

    Collins, D; Jobanputra, K; Frost, T; Muhammed, S; Ward, A; Shafei, A; Fardous, T; Gabashneh, S; Heneghan, C (BioMed Central, 2017-07-17)
    The growing burden of non-communicable diseases (NCDs) presented new challenges for medical humanitarian aid and little was known about primary health care approaches for these diseases in humanitarian response. We aimed to evaluate Médecins Sans Frontières (MSF's) use of total CVD risk based prevention strategies amongst Syrian refugees in northern Jordan to identify opportunities to improve total CVD risk based guidance for humanitarian settings.
  • Diabetes Care in a Complex Humanitarian Emergency Setting: A Qualitative Evaluation

    Murphy, A; Biringanine, M; Roberts, B; Stringer, B; Perel, P; Jobanputra, K (BioMed Central, 2017-06-23)
    Evidence is urgently needed from complex emergency settings to support efforts to respond to the increasing burden of diabetes mellitus (DM). We conducted a qualitative study of a new model of DM health care (Integrated Diabetic Clinic within an Outpatient Department [IDC-OPD]) implemented by Médecins Sans Frontières (MSF) in Mweso Hospital in eastern Democratic Republic of Congo (DRC). We aimed to explore patient and provider perspectives on the model in order to identify factors that may support or impede it.
  • Peripheral Neuropathy in a Diabetic Child Treated with Linezolid for Multidrug-Resistant Tuberculosis: A Case Report and Review of the Literature

    Swaminathan, A; du Cros, P; Seddon, J; Mirgayosieva, S; Asladdin, R; Dusmatova, Z (BioMed Central, 2017-06-12)
    Extensively drug-resistant (XDR) tuberculosis (TB) and multidrug resistant (MDR)-TB with additional resistance to injectable agents or fluoroquinolones are challenging to treat due to lack of available, effective drugs. Linezolid is one of the few drugs that has shown promise in treating these conditions. Long-term linezolid use is associated with toxicities such as peripheral and optic neuropathies. Diabetes mellitus (DM), especially when uncontrolled, can also result in peripheral neuropathy. The global burden of DM is increasing, and DM has been associated with a three-fold increased risk of developing TB disease. TB and DM can be a challenging combination to treat. DM can inhibit the host immune response to tuberculosis infection; and TB and some anti-TB drugs can worsen glycaemic control. A child experiencing neuropathy that is a possible complication of both DM and linezolid used to treat TB has not been reported previously. We report peripheral neuropathy in a 15-year-old boy with type 1 DM, diagnosed with MDR-TB and additional resistance to injectable TB medications.
  • Non-communicable diseases - programmatic and clinical guidelines

    Jobanputra, Kiran; Manson Unit, MSF UK, London (2016-12)
  • Three Steps to Improve Management of Noncommunicable Diseases in Humanitarian Crises

    Jobanputra, K; Boulle, P; Roberts, B; Perel, P (Public Library of Science, 2016-11-08)
    Kiran Jobanputra and colleagues argue that better evidence, guidance, and tools are needed to improve the effectiveness and feasibility of noncommunicable disease care in humanitarian settings.
  • Care of Non-Communicable Diseases in Emergencies

    Slama, S; Kim, HJ; Roglic, G; Boulle, P; Hering, H; Varghese, C; Rasheed, S; Tonelli, M (Elsevier, 2016-09-13)
  • Cost of Hospitalization for Non-Communicable Diseases in India: Are We Pro-Poor?

    Tripathy, J P; Prasad, B M; Shewade, H D; Kumar, A M; Zachariah, R; Chadha, S; Tonsing, J; Harries, A D (Wiley-Blackwell, 2016-06-02)
    Objectives: To estimate out-of-pocket (OOP) expenditure due to hospitalization from NCDs and its impact on households in India.
  • Task Shifting the Management of Non-Communicable Diseases to Nurses in Kibera, Kenya: Does It Work?

    Some, D; Edwards, J K; Reid, T; Van den Bergh, R; Kosgei, R J; Wilkinson, E; Baruani, B; Kizito, W; Khabala, K; Shah, S; Kibachio, J; Musembi, P (Public Library of Science, 2016-01-26)
    In sub-Saharan Africa there is an increasing need to leverage available health care workers to provide care for non-communicable diseases (NCDs). This study was conducted to evaluate adherence to Médecins Sans Frontières clinical protocols when the care of five stable NCDs (hypertension, diabetes mellitus type 2, epilepsy, asthma, and sickle cell) was shifted from clinical officers to nurses.
  • A First Country-Wide Review of Diabetes Mellitus Care in Bhutan: Time to Do Better

    Zam, K; Kumar, A M; Achanta, S; Bhat, P; Naik, B; Zangpo, K; Dorji, T; Wangdi, Y; Zachariah, R (BMC Public Health, 2015-09-21)
    There is an increasing trend of non-communicable diseases in Bhutan including Diabetes Mellitus (DM). To address this problem, a National Diabetes Control Programme was launched in 1996. There is anecdotal evidence that many patients do not visit the DM clinics regularly, but owing to lack of cohort monitoring, the magnitude of such attrition from care is unknown. Knowledge of the extent of this problem will provide a realistic assessment of the situation on the ground and would be helpful to initiate corrective actions. In this first country-wide audit, we thus aimed to determine among type 2 DM patients registered for care the i) pre-treatment attrition ii) one-year programme outcomes including retention in care, died and Lost-to-follow-up (LTFU, defined as not having visited the clinic at least once within a year of registration) iii) factors associated with attrition from care (death + LTFU) and iv) quality of follow-up care, measured by adherence to recommended patient-monitoring protocols including glycaemic control.