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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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World NTD Day

World NTD Day

Neglected tropical diseases (NTDs) impact nearly 1.7 billion people each year, causing serious illness or lifelong disability among many—often leading to stigma and exclusion—and killing an estimated 200,000. The vast majority of sufferers live in the world’s poorest countries.


The World Health Organization’s NTD roadmap 2021-2030 aims to address 20 tropical diseases through prevention, control, elimination, and/or eradication. But despite some progress, reaching all its targets will take better, far more accessible diagnostics and treatments along with more robust strategies, political commitment and resources.


To mark World NTD Day, this collection spotlights work by MSF and collaborators on improving approaches to snakebite envenoming, kala azar and noma. One study presents an innovative artificial intelligence-based snakebite diagnostic tool, while others evaluate shorter, less toxic drug regimens or different models of care. Several commentaries advocate for national/regional strategies adapted to contexts ranging from remote villages to active conflict zones. Another crucial factor is the climate crisis, which is intensifying the transmission and geographic spread of many NTDs.

Snake envenoming: a neglected crisis

Snake envenoming: a neglected crisis
Safe abortion care at MSF

Safe abortion care at MSF
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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 major 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 29,000 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.


To mark International Safe Abortion Awareness Day (28 September 2024), this Collection presents highlights of MSF’s work on safe abortion care (SAC) as a way to reduce maternal death and injury. By re-assessing and reshaping how our projects deliver SAC in fragile and conflict-affected settings, we have been able to significantly expand services in those contexts and across MSF projects globally. In parallel, we also conducted in-depth studies of abortion complications and their contributing factors in fragile settings, where a dearth of evidence limits understanding of women's needs in accessing comprehensive care. These findings are helping to identify gaps in service delivery and inform operational decision-making.

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...