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MSF OCA NCD Guidelines version 4

Title: MSF OCA NCD Guidelines version 4 Authors: MSF Description: Non-communicable diseases (NCDs) make the largest contribution to mortality both globally and in the majority of low- and middle- income countries (LMICs). Worldwide, NCDs account for 60% (35 million) of global deaths. The major NCDs used to be diseases of affluence; however, the changing epidemiology of NCDs (increasingly affecting low- and middle-income countries) and the changing patterns of refugee crises (away from settings where infectious disease represents the main burden of disease) mean that they now represent an increasing proportion of the cases we see in many MSF projects.

Field Research Survey

Title: Field Research Survey Authors: MSF USA; LuxOR Description: To access the survey, click on Additional Links.

Estimating program coverage in the treatment of severe acute malnutrition: a comparative analysis of the validity and operational feasibility of two methods

Title: Estimating program coverage in the treatment of severe acute malnutrition: a comparative analysis of the validity and operational feasibility of two methods Authors: Isanaka, S; Hedt-Gauthier, BL; Grais, RF; Allen, BGS Abstract: Many health programs can assess coverage using standardized cluster survey methods, but estimating the coverage of nutrition programs presents a special challenge due to low disease prevalence. Used since 2012, the Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) employs both qualitative and quantitative methods to identify key barriers to access and estimate coverage of therapeutic feeding programs. While the tool has been increasingly used in programs, the validity of certain methodological elements has been the subject of debate.

Is 6 months of bedaquiline enough? Results from the compassionate use of bedaquiline in Armenia and Georgia

Title: Is 6 months of bedaquiline enough? Results from the compassionate use of bedaquiline in Armenia and Georgia Authors: Hewison, C; Bastard, M; Khachatryan, N; Kotrikadze, T; Hayrapetyan, A; Avaliani, Z; Kiria, N; Yegiazaryan, L; Chumburidze, N; Kirakosyan, O; Atshemyan, H; Qayyum, S; Lachenal, N; Varaine, F; Huerga, H Abstract: Bedaquiline (BDQ) was initially only available through compassionate use programmes.

Determinants of dietary practices during pregnancy: A longitudinal qualitative study in Niger

Title: Determinants of dietary practices during pregnancy: A longitudinal qualitative study in Niger Authors: Rosen, JG; Clermont, A; Kodish, SR; Seck, AM; Salifou, A; Grais, RF; Isanaka, S Abstract: Undernutrition is associated with maternal morbidity and poor pregnancy outcomes. This qualitative study seeks to understand the multilevel factors influencing maternal dietary practices in Niger, including the impact of pregnancy illnesses on diet. Criterion-based, purposive sampling was used to select pregnant women and household members from 24 villages in a rural district of the Maradi Region in south-central Niger. Semistructured interviews (n = 153) and focus group discussions (n = 38) explored 4 primary themes: (a) perceptions of ideal diet during pregnancy, (b) barriers to consuming the ideal diet, (c) coping strategies including dietary responses related to pregnancy illnesses, and (d) changes in perceptions from early to late pregnancy. Longitudinal data collection allowed for repeated interviews of pregnant women to document changes in dietary practices throughout pregnancy. Transcripts were coded using an inductive approach informed by grounded theory methodology. Participants categorized foods into 4 primary dietary taxonomies when discussing ideal maternal diets but cited constraints related to accessibility and availability impeding routine consumption of these foods. Perceptions of "modern," urban foods as healthy, coupled with key structural barriers such as food costs, were identified. Maternal morbidity influenced food consumption, as women reported reducing food intake early in pregnancy in response to illness episodes. Although awareness of optimal foods for supporting healthy pregnancies was moderately high, some misconceptions were observed and multilevel barriers to food security restricted opportunities for consuming these foods. Nutrition-specific and nutrition-sensitive interventions could improve access and availability of acceptable foods for supporting increased dietary intake during pregnancy.

Seroprevalence and risk factors of recent infection with hepatitis E virus during an acute outbreak in an urban setting in Chad, 2017

Title: Seroprevalence and risk factors of recent infection with hepatitis E virus during an acute outbreak in an urban setting in Chad, 2017 Authors: Vernier, L; Lenglet, A; Hogema, BM; Moussa, AM; Ariti, C; Vollmer, S; Irwin, A; Alfani, P; Sang, S; Kamau, C Abstract: From September 2016-April 2017, Am Timan, Chad, experienced a large HEV outbreak in an urban setting with a limited impact in terms of morbidity and mortality. To better understand HEV epidemiology in this context, we estimated the seroprevalence of anti-HEV antibodies (IgM and IgG) and assessed the risk factors for recent HEV infections (positive anti-HEV IgM) during this outbreak.

Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial

Title: Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial Authors: Coldiron, ME; Assao, B; Page, A; Hitchings, MDT; Alcoba, G; Ciglenecki, I; Langendorf, C; Mambula, C; Adehossi, E; Sidikou, F; Tassiou, EI; De Lastours, V; Grais, RF Abstract: Antibiotic prophylaxis for contacts of meningitis cases is not recommended during outbreaks in the African meningitis belt. We assessed the effectiveness of single-dose oral ciprofloxacin administered to household contacts and in village-wide distributions on the overall attack rate (AR) in an outbreak of meningococcal meningitis.

Survey report OCA Southern Syria

Title: Survey report OCA Southern Syria Authors: MSF Description: Conducted in Dar’aa and Quneitra,during a cease fire in 2017, this study attempted to provide a baseline of health care needs and barriers to accessing health care. By triangulating information sources, we have attempted to cover important health care subjects from different perspectives.

Are village health volunteers as good as basic health staffs in providing malaria care? A country wide analysis from Myanmar, 2015

Title: Are village health volunteers as good as basic health staffs in providing malaria care? A country wide analysis from Myanmar, 2015 Authors: Linn, NYY; Kathirvel, S; Das, M; Thapa, B; Rahman, Mm; Maung, TM; Kyaw, AMM; Thi, A; Lin, Z Abstract: Malaria is one of the major public health problems in Myanmar. Village health volunteers (VHV) are the key malaria diagnosis and treatment service provider at community level in addition to basic health staffs (BHS). This countrywide analysis aimed to assess and compare the accessibility to- and quality of malaria care (treatment initiation, treatment within 24 h and complete treatment delivery) between VHV and BHS in Myanmar.

Standardized Nutrition Surveys

Title: Standardized Nutrition Surveys Authors: MSF Description: The guideline starts with the assumption that the need to carry out a nutrition survey, in an area where MSF is working, has been discussed with all decision makers at headquarters and field level. This is stipulated in criterion two of ”surveys based on the standardised intersectional survey protocols, approved by the MSF ERB”. Moreover, it was agreed to perform the nutrition survey to better evaluate the health status of the population living in the MSF catchment area.

Sub-national variation in measles vaccine coverage and outbreak risk: a case study from a 2010 outbreak in Malawi

Title: Sub-national variation in measles vaccine coverage and outbreak risk: a case study from a 2010 outbreak in Malawi Authors: Kundrick, A; Huang, Z; Carran, S; Kagoli, M; Grais, RF; Hurtado, N; Ferrari, M Abstract: Despite progress towards increasing global vaccination coverage, measles continues to be one of the leading, preventable causes of death among children worldwide. Whether and how to target sub-national areas for vaccination campaigns continues to remain a question. We analyzed three metrics for prioritizing target areas: vaccination coverage, susceptible birth cohort, and the effective reproductive ratio (RE) in the context of the 2010 measles epidemic in Malawi.

'When Ebola enters a home, a family, a community': A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone

Title: 'When Ebola enters a home, a family, a community': A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone Authors: Gray, N; Stringer, B; Bark, G; Heller Perache, A; Jephcott, F; Broeder, R; Kremer, R; Jimissa, AS; Samba, TT Abstract: During the West Africa Ebola outbreak, cultural practices have been described as hindering response efforts. The acceptance of control measures improved during the outbreak, but little is known about how and why this occurred. We conducted a qualitative study in two administrative districts of Sierra Leone to understand Ebola survivor, community, and health worker perspectives on Ebola control measures. We aimed to gain an understanding of community interactions with the Ebola response to inform future intervention strategies.

Hepatitis C Virus Diagnosis and the Holy Grail

Title: Hepatitis C Virus Diagnosis and the Holy Grail Authors: Applegate, TL; Fajardo, E; Sacks, JA Abstract: The world has embraced the call for global elimination of hepatitis C virus by 2030. The unprecedented speed of therapeutic development and increased access to direct-acting antivirals has made elimination a possibility. We must screen hundreds of millions of people to diagnose and treat those currently infected. Global access to hepatitis C virus diagnostics will be a keystone to success. Key challenges must be overcome and systems optimized to ensure widespread access to existing diagnostics. Although promising technologies may soon transform the landscape, innovative strategies are needed to stimulate investment and accelerate the development of point-of-care hepatitis C virus diagnostics.

Evaluation of the SD Bioline Cholera Rapid Diagnostic Test During the 2016 Cholera Outbreak in Lusaka, Zambia

Title: Evaluation of the SD Bioline Cholera Rapid Diagnostic Test During the 2016 Cholera Outbreak in Lusaka, Zambia Authors: Mwaba, J; Ferreras, E; Chizema-Kawesa, E; Mwimbe, D; Tafirenyika, F; Rauzier, J; Blake, A; Rakesh, A; Poncin, M; Stoitsova, S; Kwenda, G; Azman, AS; Chewe, O; Serafini, M; Lukwesa-Musyani, C; Cohuet, S; Quilici, M; Luquero, FJ; Page, A Abstract: To assess the performance of the SD Bioline Cholera Ag O1/O139 rapid diagnostic test (RDT) compared to a reference standard combining culture and PCR for the diagnosis of cholera cases during an outbreak.

Wishful thinking versus operational commitment: is the international guidance on priority sexual and reproductive health interventions in humanitarian settings becoming unrealistic?

Title: Wishful thinking versus operational commitment: is the international guidance on priority sexual and reproductive health interventions in humanitarian settings becoming unrealistic? Authors: Tran, NT; Schulte-Hillen, C Abstract: Twenty-one years ago, a global consortium of like-minded institutions designed the landmark Minimum Initial Service Package (MISP) for sexual and reproductive health (SRH) to guide national and international humanitarian first responders in preventing morbidity and mortality at the onset of chaos, destruction, and high insecurity caused by disasters or conflicts. Since then, the MISP has undergone limited change and has become an international reference in humanitarian response. This article discusses our perspectives regarding the 2018 changes to the MISP that have created division among humanitarian field practitioners, academics, advocates, and development agencies. With more than 50 pages, the new MISP chapter dilutes key guidance and messages on the most life-saving activities, leaving actors with excessive room for interpretation as to which priority activities need to be first implemented. Consequently, non-life-saving interventions may take precedence over essential ones. Insecurity, scarce human and financial resources, logistics constrains, and other limitations imposed by field reality at the onset of a crisis must be considered. We strongly recommend that an institution with the mandate, legitimacy, and technical expertise in the review of guidelines reexamines the 2018 edition of the MISP. We urge experienced first-line responders, national actors, and relevant agencies to join efforts to ensure that the MISP remains focused on a very limited set of essential activities and supplies that are pragmatic, field-oriented, and, most importantly, immediately life-saving for people in need.

When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings

Title: When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings Authors: Umphrey, L; Breindahl, M; Brown, A; Saugstad, OD; Thio, M; Trevisanuto, D; Roehrg, CC; Blennow, M Abstract: Neonatal resuscitation (NR) combines a set of life-saving interventions in order to stabilize compromised newborns at birth or when critically ill. Médecins Sans Frontières/Doctors Without Borders (MSF), as an international medical-humanitarian organization working particularly in low-resource settings (LRS), assisted over 250,000 births in obstetric and newborn care aid projects in 2016 and provides thousands of newborn resuscitations annually. The Helping Babies Breathe (HBB) program has been used as formal guidance for basic resuscitation since 2012. However, in some MSF projects with the capacity to provide more advanced NR interventions but a lack of adapted guidance, staff have felt prompted to create their own advanced algorithms, which runs counter to the organization's aim for standardized protocols in all aspects of its care.

New insights into leishmaniasis in the immunosuppressed

Title: New insights into leishmaniasis in the immunosuppressed Authors: Akuffo, H; Costa, C; van Griensven, J; Burza, S; Moreno, J; Herrero, M Abstract: Immunosuppression contributes significantly to the caseload of visceral leishmaniasis (VL). HIV coinfection, solid organ transplantation, malnutrition, and helminth infections are the most important immunosuppression-related factors. This review briefly describes the challenges of these associations. East Africa and the Indian subcontinent are the places where HIV imposes the highest burden in VL. In the highlands of Northern Ethiopia, migrant rural workers are at a greater risk of coinfection and malnutrition, while in India, HIV reduces the sustainability of a successful elimination programme. As shown from a longitudinal cohort in Madrid, VL is an additional threat to solid organ transplantation. The association with malnutrition is more complex since it can be both a cause and a consequence of VL. Different regimes for therapy and secondary prevention are discussed as well as the role of nutrients on the prophylaxis of VL in poverty-stricken endemic areas.

Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy

Title: Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy Authors: Pane, S; Giancola, ML; Piselli, P; Corpolongo, A; Repetto, E; Bellagamba, R; Cimaglia, C; Carrara, S; Ghirga, P; Oliva, A; Bevilacqua, N; Al Rousan, A; Nisii, C; Ippolito, G; Nicastri, E Abstract: Chagas disease (CD) is a systemic parasitic infection caused by the protozoan Trypanosoma cruzi, whose chronic phase may lead to cardiac and intestinal disorders. Endemic in Latin America where it is transmitted mainly by vectors, large-scale migrations to other countries have turned CD into a global health problem because of its alternative transmission routes through blood transfusion, tissue transplantation, or congenital. Aim of this study was to compare the performance of two commercially available tests for serological diagnosis of CD in a group of Latin American migrants living in a non-endemic setting (Rome, Italy). The study was based on a cross-sectional analysis of seroprevalence in this group. Epidemiological risk factors associated to CD were also evaluated in this study population.

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