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Diabetes care in humanitarian settings | Collections | MSF Science Portal
Diabetes care in humanitarian settings

Diabetes care in humanitarian settings

Diabetes affect hundreds of millions of people worldwide, a large majority of them living in low- and middle-income countries. Yet finding effective strategies, tools and policies for effectively managing this chronic illness—especially amid war, displacement or exclusion from care—is a neglected area of humanitarian medicine.

Here we present a cross-section of work on this front by MSF and collaborators. Several studies assess the shift towards community-based, nurse-led models of care in rural settings. Others explore obstacles to diabetes care for war refugees living in camps in Jordan or Lebanon, highlighting how health programs can adapt to their needs. The demonstration that insulin retains potency for 30 days if cooled without refrigeration is opening doors to more patient self-management, as a case study in remote South Sudan shows.

At the same time, MSF and others call for regulatory and financing policies that make diabetes medications and supplies cheaper, better adapted to humanitarian settings, and far more available to patients whose lives depend on them.

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TB-PRACTECAL Trial—Evidence for a shorter, safer, more effective treatment for drug-resistant tuberculosis

TB-PRACTECAL Trial—Evidence for a shorter, safer, more effect...
Drug-resistant tuberculosis (DR-TB) remains an especially deadly form of the ancient scourge of TB, while current treatments are long, toxic, and ineffective for half of all patients. Aiming to change this unacceptable status quo, in the mid-2010’s MSF and partners launched three clinical trials to test novel regimens containing the first new TB drugs in decades. On 22 December 2022 the New England Journal of Medicine published findings from TB-PRACTECAL, a three-country randomized controlled trial, showing that a shorter regimen is safer and cured 89% of DR-TB patients, compared with 52% on the standard of care. These findings have already been incorporated into the World Health Organization’s new TB treatment guidelines. A separate study shows that the new regimen is also more cost-effective. Alongside these results the content collection linked below highlights other aspects of the trial, from community engagement strategies that helped shape TB-PRACTECAL to setbacks arising from the Covid-19 pandemic. It also examines urgent challenges in scaling up access to these life-saving drugs, including affordability and patent barriers.
Snake envenoming: a neglected crisis

Snake envenoming: a neglected crisis
International Safe Abortion Day 2022

International Safe Abortion Day 2022
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Every year 2 million or more people fall victim to snakebite envenoming, mostly in poor, rural communities of Africa, Asia and Latin America. Between 83,000—138,000 of them die, while hundreds of thousands more suffer debilitating long-term complications or disabilities.


Although some antivenom medicines are highly effective when used promptly and appropriately, many snakebite victims get no treatment at all. Those who do may receive antivenoms which don’t work against the type of snake that bit them, or were not rigorously tested for safety and effectiveness.


To mark World Snakebite Awareness Day on September 19th, the Collection linked below brings together recent MSF work on this highly neglected disease. Several articles and conference presentations help fill evidence gaps on the burden of disease and its impacts or on treatment outcomes with specific antivenoms in specific regions. Others examine how to tackle the formidable challenges of availability and affordability, the absence of regulatory oversight for making, testing and registering antivenoms, and the anemic R&D pipeline for new products—all of which impede access for patients to safe, effective treatment tailored to local snake species.

Unsafe abortion is a leading cause of maternal death, and the only one that is completely preventable. Yet over 30 million unsafe abortions occur each year, leading to at least 28,000 deaths and millions of serious complications—nearly all in low- and middle-income countries. MSF teams see these tragic consequences first-hand, treating thousands of patients every year with severe, potentially life-threatening effects from unsafe abortion. So in 2016 we launched a program to systematically implement safe abortion care (SAC), starting with ten pilot sites and then applying the lessons learned to scale up at projects across the globe. This Collection presents highlights of these efforts. Since our first publication on the need to provide SAC as a way of reducing maternal death and injury, several studies assessed the role of unsafe abortion in driving this suffering in specific contexts. Others described internal obstacles to providing SAC, operational solutions developed, and outcomes achieved. And we advocated for shifting towards community-led and self-managed SAC, particularly given new obstacles that emerged during the Covid-19 pandemic.
Journal Article
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Research

Estimated sustainable cost-based prices for diabetes medicines

Barber MJ, Gotham D, Bygrave H, Cepuch C
2024-03-27 • JAMA Network Open
2024-03-27 • JAMA Network Open
IMPORTANCE
The burden of diabetes is growing worldwide. The costs associated with diabetes put substantial pressure on patients and health budgets, especially in low- and middle-inco...
Conference Material
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Poster

Evaluating task-sharing for non-communicable disease management in humanitarian settings: lessons learned from MSF’s model of care in Lebanon

Doumit M, Masri S, Beltran I, Incerti A, Ciglenecki I,  et al.
2023-06-07 • MSF Scientific Day International 2023
2023-06-07 • MSF Scientific Day International 2023
Journal Article
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Commentary

A framework for improving diabetes care in humanitarian emergencies

Kehlenbrink S, Jobanputra K, International Alliance for Diabetes Action
2023-03-01 • Lancet Diabetes and Endocrinology
2023-03-01 • Lancet Diabetes and Endocrinology
Conference Material
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Poster

Recurrent DKA reduced by home glucose monitoring and clay pot insulin storage in a low resource setting - a case report

Simon M, Seignoux J, Fadumiyo A, Muderhwa Y
2022-11-30 • MSF Paediatric Days 2022
2022-11-30 • MSF Paediatric Days 2022
Conference Material
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Poster

Decentralization of insulin treatment through nurses and clinical officers in nine health centres in a rural county, Kenya: descriptive study

Borum Mølskov Bech M, Otieno Khisa A, Ndoca K, Ayuaya T, Kajuju P,  et al.
2022-05-09 • MSF Scientific Days International 2022
2022-05-09 • MSF Scientific Days International 2022
Journal Article
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Letter

Diabetes and the WHO model list of essential medicines

Reddy A
2022-01-01 • Lancet Diabetes and Endocrinology
2022-01-01 • Lancet Diabetes and Endocrinology
Journal Article
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Research

MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

Ansbro É, Homan T, Qasem J, Bil K, Tarawneh M,  et al.
2021-04-26 • BMC Health Services Research
2021-04-26 • BMC Health Services Research
BACKGROUND
In response to the rising global NCD burden, humanitarian actors have rapidly scaled-up NCD services in crisis-affected low-and-middle income countries. Using the RE-AIM i...
Journal Article
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Review

Operational considerations for the management of non-communicable diseases in humanitarian emergencies

Bausch FJ, Beran D, Hering H, Boulle P, Chappuis F,  et al.
2021-02-25 • Conflict and Health
2021-02-25 • Conflict and Health
Non-communicable diseases (NCD) represent an increasing global challenge with the majority of mortality occurring in low- and middle-income countries (LMICs). Concurrently, many humanita...
Journal Article
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Research

Heat-stability study of various insulin types in tropical temperature conditions: new insights towards improving diabetes care

Kaufmann B, Boulle P, Berthou F, Fournier M, Beran D,  et al.
2021-02-03 • PLOS One
2021-02-03 • PLOS One
Strict storage recommendations for insulin are difficult to follow in hot tropical regions and even more challenging in conflict and humanitarian emergency settings, adding an extra burd...
Journal Article
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Research

Setting up a nurse-led model of care for management of hypertension and diabetes mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive study

Frieden M, Zamba B, Mukumbi N, Mafaune PT, Makumbe B,  et al.
2020-06-01 • BMC Health Services Research
2020-06-01 • BMC Health Services Research
BACKGROUND
In the light of the increasing burden of non-communicable diseases (NCDs) on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, contex...