On 3-4 May in Nairobi, Kenya, MSF gathered staff from our projects with experts from academia, clinical practice and the non-governmental sector to consider key issues in humanitarian paediatrics. These included:
Vaccination and vaccine-preventable diseases: Amid post-Covid-19 global setbacks in child vaccination coverage, sessions spotlighted recent increases in vaccine-preventable disease outbreaks, potential new vaccination strategies and emergency responses, and MSF’s role in vaccine advocacy and catch-up campaigns.
Nutrition: Talks covered the nexus of nutrition with other key conference topics, the latest malnutrition guidance and tools, and MSF’s priorities in nutritional care.
Paediatric HIV: With half of all HIV-positive children globally not receiving antiretroviral therapy, presenters reviewed the latest paediatric testing/treatment recommendations and discussed barriers and potential solutions to implementation, nutritional challenges in children with HIV, and systems strengthening for preventing and monitoring paediatric HIV.
Click below to read the abstracts. And stay tuned for more conference content, coming soon.
13 result(s)
Conference Material > Abstract
Bigirimana T, Thind A, Hawa Diallo O, Kourouma A, Burzio C, et al.
MSF Paediatric Days 2024. 4 May 2024
BACKGROUND AND OBJECTIVES
In 2016, UNAIDS identified the Prevention of Mother-to-Child Transmission of HIV (PMTCT) as a significant challenge in the fight against HIV/AIDS in Guinea. This abstract presents the key findings of an evaluation conducted on the PMTCT component of MSF's HIV project in Guinea, implemented since the early 2000’s. The main objective of the evaluation was to assess its relevance, coherence, effectiveness, efficiency, impact, and sustainability.
METHODS
A mixed quantitative and qualitative methodology was applied, including a desk review of MSF project documents, field observations, and interviews with key stakeholders. The data were analysed by triangulation and benchmarking to ensure internal validity. Quantitative indicators provided information on the number of women receiving PMTCT treatment and the rate of HIV mother-to-child transmission (MTCT) in health facilities supported by MSF, allowing the measurement of the effectiveness of the intervention. The quality of data and the lack of primary data from 2011 to 2015 was the main limitation, hindering the calculation of statistical significance (p-value) for the observed change in the rate of MTCT of HIV.
RESULTS
MSF's PMTCT intervention was highly relevant and aligned with the country's needs. It demonstrated effectiveness through the significant number of women receiving PMTCT treatment, the establishment of a platform for viral load testing, drug supply support, and a reduction in the HIV MTCT rate. The rate of MTCT in health facilities supported by MSF decreased from 35.9% to 12% [7 – 12] between 2010 and 2021. The challenges relating to data accuracy, monitoring activities, the follow-up of babies born from HIV-infected mothers, and the readiness of the MoH to take over the programme were identified, highlighting the need for improvement to enhance the effectiveness and efficiency. Sustainability efforts remained low as the Guinean health system lacked enough funding to take over the programme.
CONCLUSIONS
The evaluation affirms the positive impact of the PMTCT intervention in reducing MTCT of HIV, even if project target (5%) was not achieved. Recommendations aim to strengthen investment in PMTCT and enhance the hand-over strategy to ensure sustainability after MSF exit.
In 2016, UNAIDS identified the Prevention of Mother-to-Child Transmission of HIV (PMTCT) as a significant challenge in the fight against HIV/AIDS in Guinea. This abstract presents the key findings of an evaluation conducted on the PMTCT component of MSF's HIV project in Guinea, implemented since the early 2000’s. The main objective of the evaluation was to assess its relevance, coherence, effectiveness, efficiency, impact, and sustainability.
METHODS
A mixed quantitative and qualitative methodology was applied, including a desk review of MSF project documents, field observations, and interviews with key stakeholders. The data were analysed by triangulation and benchmarking to ensure internal validity. Quantitative indicators provided information on the number of women receiving PMTCT treatment and the rate of HIV mother-to-child transmission (MTCT) in health facilities supported by MSF, allowing the measurement of the effectiveness of the intervention. The quality of data and the lack of primary data from 2011 to 2015 was the main limitation, hindering the calculation of statistical significance (p-value) for the observed change in the rate of MTCT of HIV.
RESULTS
MSF's PMTCT intervention was highly relevant and aligned with the country's needs. It demonstrated effectiveness through the significant number of women receiving PMTCT treatment, the establishment of a platform for viral load testing, drug supply support, and a reduction in the HIV MTCT rate. The rate of MTCT in health facilities supported by MSF decreased from 35.9% to 12% [7 – 12] between 2010 and 2021. The challenges relating to data accuracy, monitoring activities, the follow-up of babies born from HIV-infected mothers, and the readiness of the MoH to take over the programme were identified, highlighting the need for improvement to enhance the effectiveness and efficiency. Sustainability efforts remained low as the Guinean health system lacked enough funding to take over the programme.
CONCLUSIONS
The evaluation affirms the positive impact of the PMTCT intervention in reducing MTCT of HIV, even if project target (5%) was not achieved. Recommendations aim to strengthen investment in PMTCT and enhance the hand-over strategy to ensure sustainability after MSF exit.
Conference Material > Abstract
Mairos Ferreira S, Muthengi K, Mohale M, Mokhameleli S, Mathosi L
MSF Paediatric Days 2024. 4 May 2024
BACKGROUND AND OBJECTIVES
This research emerges from Lesotho's diverse landscapes, where children’s stories remain largely unheard in the realm of health policy. The study aims to harness these narratives to drive equity, inclusivity, and human rights in health interventions, positioning youth not just as beneficiaries but as active participants in all health interventions.
METHODS
This research represents a meta-analysis of a larger, cross-sectional, qualitative research project, focused on understanding childrens’ narratives and experiences on their health and wellbeing. The study employed Participatory Learning Approach (PLA) tools, notably Social and Resource Mapping, Body Mapping, and Cause and Effect Analysis, to delve into these narratives. It involved a purposeful sample of 180 children, ranging from 6 to 19 years old, including school-goers, herd boys, children with disabilities, and teenagers. It occurred in diverse regions of Lesotho (Lowlands, Mountains, Foothills, and Senqu River Valley). This comprehensive approach also encompassed 18 Focus Group Discussions, enriched by Key Informant Interviews with local stakeholders.
RESULTS
Key findings from this study highlight significant issues in health, Water, Sanitation and Hygiene (WASH), education, nutrition, and child protection. The study underscores the challenges in accessing general healthcare services, particularly stressing the importance of sexual and reproductive health in high HIV/AIDS prevalence areas. The need for improved water and sanitation infrastructure is critically emphasised. In education, children and youth advocate for greater equity and inclusivity. The impact of climate change on nutrition is evident, leading to food insecurity and malnutrition, with high prevalence of stunting. Participants highlighted key facets of child protection, emphasising the increased vulnerability and exploitation of children and youth, alongside a considerable risk of gender-based and sexual violence.
CONCLUSIONS
Participants powerful testimonies advocate for a paradigm shift towards more inclusive and youth-involved policymaking, challenging the dominance of adult-centric approaches and calling for a holistic integration of their perspectives in programmes and policies.
This research emerges from Lesotho's diverse landscapes, where children’s stories remain largely unheard in the realm of health policy. The study aims to harness these narratives to drive equity, inclusivity, and human rights in health interventions, positioning youth not just as beneficiaries but as active participants in all health interventions.
METHODS
This research represents a meta-analysis of a larger, cross-sectional, qualitative research project, focused on understanding childrens’ narratives and experiences on their health and wellbeing. The study employed Participatory Learning Approach (PLA) tools, notably Social and Resource Mapping, Body Mapping, and Cause and Effect Analysis, to delve into these narratives. It involved a purposeful sample of 180 children, ranging from 6 to 19 years old, including school-goers, herd boys, children with disabilities, and teenagers. It occurred in diverse regions of Lesotho (Lowlands, Mountains, Foothills, and Senqu River Valley). This comprehensive approach also encompassed 18 Focus Group Discussions, enriched by Key Informant Interviews with local stakeholders.
RESULTS
Key findings from this study highlight significant issues in health, Water, Sanitation and Hygiene (WASH), education, nutrition, and child protection. The study underscores the challenges in accessing general healthcare services, particularly stressing the importance of sexual and reproductive health in high HIV/AIDS prevalence areas. The need for improved water and sanitation infrastructure is critically emphasised. In education, children and youth advocate for greater equity and inclusivity. The impact of climate change on nutrition is evident, leading to food insecurity and malnutrition, with high prevalence of stunting. Participants highlighted key facets of child protection, emphasising the increased vulnerability and exploitation of children and youth, alongside a considerable risk of gender-based and sexual violence.
CONCLUSIONS
Participants powerful testimonies advocate for a paradigm shift towards more inclusive and youth-involved policymaking, challenging the dominance of adult-centric approaches and calling for a holistic integration of their perspectives in programmes and policies.
Conference Material > Abstract
Rubona F, Ibongu E, Bah AJ, Dianouni F, Wepnyui H
MSF Paediatric Days 2024. 4 May 2024
BACKGROUND AND OBJECTIVES Le Centre de Sante de Référence de Douentza fait face à des nombreux défis des soins néonataux exacerbés par le contexte d’accès très limités. Plusieurs initiatives ont été envisagées notamment le support continu du Pédiatre, analyses des causes des décès et définition des plans d’action, formation au lit des malades. Pour accéder et accompagner le personnel soignant, une formation virtuelle intersectionnelle des soins néonataux a été réalisée pendant 2,5 mois pour une équipe de 7 staffs (infirmières et médecins). Le partage de cette expérience a comme objectif de montrer les bonnes pratiques possibles dans ces contextes. CASE DESCRIPTION Après cette formation virtuelle interactive, l’équipe a pris l’initiative d’identifier les grands défis à relever pour améliorer les soins néonataux à travers une évaluation approfondie (arbre à problèmes) des pratiques de soins dans le projet. La collecte d’informations comprenait des observations sur place à travers des entretiens avec le personnel de santé et avec des accompagnants, des dossiers des patients ainsi que les audits de décès. Définition et implémentation du plan d’amélioration qui a permis : • Réorganisation de la salle de néonatologie en fonction du degré d’urgence : rouge, orange, vert, zone de réanimation. • Meilleure acceptance en interne et sensibilisation sur les soins de la mère kangourou et zéro séparation. • Mise en place et maitrise du protocole de prise en charge (PEC) et de la réanimation néonatale. • Consensus et adoption des critères de PEC (admissions, référence, soins palliatifs). • Travail en amont avec l’équipe de la Promotion de santé et engagement communautaire pour le recours précoce aux soins.
CONCLUSIONS La formation virtuelle a permis non seulement d’interagir, d’acquérir des nouvelles connaissances mais aussi l ́analyse et détection des causes profondes du problème, proposer des interventions ciblées à court et moyen terme ; définir le chronogramme d’implémentation ainsi que les indicateurs de suivi. Des changements perceptibles sont opérés et continueront pour des soins néonataux appropriés.
Conference Material > Abstract
Danno K, Worku DT, Adjaho I, Ale F, Katuala Y, et al.
MSF Paediatric Days 2024. 4 May 2024
BACKGROUND AND OBJECTIVES
Hypothermia is a major risk factor for high neonatal mortality. In January, night-time temperatures in Kano State can drop below 20°C. We conducted a study to elucidate the incidence of neonatal hypothermia at Garan Gamawa maternal and child health (MCH) clinic in Kano City, with an aim to improve midwifery care and reduce hypothermia-related neonatal mortality.
METHODS
The data of neonates born in January 2022 were collected retrospectively in February 2022. Hypothermia was defined as “axillary temperature below 35.5°C” in accordance with MSF Essential Obstetric and Newborn Care guidelines, 2019. Statistical analysis was done using a one-sided test for binomial proportions. Qualitative data was garnered by non-participatory observation (NPO) in the delivery room and postnatal care (PNC) ward to observe the warm chain and the interactions between staff and mothers. Individual semi-structured in-depth interviews were also conducted with eight MCH staff.
RESULTS
Amongst the 206 newborns included, 55 (26.69%, Wilson confidence interval 21.13- 33.13%, p value < 0.00001) developed hypothermia. From the NPO, contributing factors to hypothermia included: absence of skin-to-skin at birth; a delay of 40 minutes between birth and baby being put to the breast for their first feed; constant draught of outside air into delivery room; absence of heating system in delivery room and PNC ward; and the need to go outside during transfer between the delivery room and PNC ward. In-depth interviews illustrated that midwives prioritised dressing the babies rather than encouraging Kangaroo Mother Care (KMC), and that the warm chain was prone to interruption during a complicated delivery and when there were multiple labouring mothers. Additionally, some midwives were not aware of the definition of neonatal hypothermia.
CONCLUSIONS
The proportion of hypothermic neonates was significant, and several contributing factors were identified. Recommendations include the installation of a door into the delivery room and appropriate heating systems in both the delivery room and PNC ward. Training of MCH staff is required to build knowledge and skills regarding the maintenance of the warm chain, and highlighting the importance of immediate skin-to-skin at birth and KMC, which have an important role in preventing hypothermia and must be encouraged.
Hypothermia is a major risk factor for high neonatal mortality. In January, night-time temperatures in Kano State can drop below 20°C. We conducted a study to elucidate the incidence of neonatal hypothermia at Garan Gamawa maternal and child health (MCH) clinic in Kano City, with an aim to improve midwifery care and reduce hypothermia-related neonatal mortality.
METHODS
The data of neonates born in January 2022 were collected retrospectively in February 2022. Hypothermia was defined as “axillary temperature below 35.5°C” in accordance with MSF Essential Obstetric and Newborn Care guidelines, 2019. Statistical analysis was done using a one-sided test for binomial proportions. Qualitative data was garnered by non-participatory observation (NPO) in the delivery room and postnatal care (PNC) ward to observe the warm chain and the interactions between staff and mothers. Individual semi-structured in-depth interviews were also conducted with eight MCH staff.
RESULTS
Amongst the 206 newborns included, 55 (26.69%, Wilson confidence interval 21.13- 33.13%, p value < 0.00001) developed hypothermia. From the NPO, contributing factors to hypothermia included: absence of skin-to-skin at birth; a delay of 40 minutes between birth and baby being put to the breast for their first feed; constant draught of outside air into delivery room; absence of heating system in delivery room and PNC ward; and the need to go outside during transfer between the delivery room and PNC ward. In-depth interviews illustrated that midwives prioritised dressing the babies rather than encouraging Kangaroo Mother Care (KMC), and that the warm chain was prone to interruption during a complicated delivery and when there were multiple labouring mothers. Additionally, some midwives were not aware of the definition of neonatal hypothermia.
CONCLUSIONS
The proportion of hypothermic neonates was significant, and several contributing factors were identified. Recommendations include the installation of a door into the delivery room and appropriate heating systems in both the delivery room and PNC ward. Training of MCH staff is required to build knowledge and skills regarding the maintenance of the warm chain, and highlighting the importance of immediate skin-to-skin at birth and KMC, which have an important role in preventing hypothermia and must be encouraged.
Conference Material > Abstract
Gonzalez Arias M, Buero MM, Salem Z, Yang SL, Valori AV
MSF Paediatric Days 2024. 4 May 2024
BACKGROUND AND OBJECTIVES
Since 2015, MSF OCBA has supported Abs General Hospital (AGH) with an 88-bed capacity neonatal ward. In the recent years, annual admissions in the service escalated to an average of 3000 but with persistently high inpatient neonatal mortality rates, usually above 20%. Main causes of mortality in 2022 were prematurity (45%), perinatal asphyxia (21%) and sepsis (20%). To tackle this problem we performed an initial mortality analysis and used it to develop a workplan, which was then implemented during March – April 2023. The plan focused on improving compliance with zero-separation practices and adherence to neonatal care protocols and on reducing nosocomial infection. Specific activities, among many, included ensuring enough space for mothers to stay with their newborns in the ward and implementing a breastfeeding group with weekly meetings. Here we present our assessment of whether and how these measures may have affected neonatal mortality.
METHODS
Inpatient mortality rates of pre- and post-implementation period were compared from aggregated monthly data in MSF ́s Health Management Information System (HMIS). We conducted analysis stratified by year and by predefined periods – pre-implementation periods: January to August 22 and September 22 to February 23 (reference period) and post- implementation period: May to December 23. Mortality rate ratios (MRR) were calculated using negative binomial regression adjusted for month of admission.
RESULTS
1050 neonatal deaths and 5733 exits were included in the analysis period. Our data showed a 24% decrease in overall neonatal mortality (MRR = 0.76, 95%CI 0.60-0.95, p=0.02) during the post-implementation period compared to the reference period, with the reduction affecting all three main causes of mortality equally (prematurity accounted for 46% of all deaths post-implementation, sepsis 21%, and perinatal asphyxia 20%). A significant decrease in mortality (26%) was seen in 2023 when compared to 2022 (MRR = 0.74, 95%CI 0.65-0.85, p<0.05).
CONCLUSIONS
Neonatal mortality is usually an important challenge in MSF settings. Here we describe some low-cost strategies that have likely contributed to reducing inpatient mortality. A comprehensive approach to neonatal care with involvement of locally-hired staff seems essential for good outcomes and continuity. This experience provides valuable insights for healthcare professionals working in similar settings.
Since 2015, MSF OCBA has supported Abs General Hospital (AGH) with an 88-bed capacity neonatal ward. In the recent years, annual admissions in the service escalated to an average of 3000 but with persistently high inpatient neonatal mortality rates, usually above 20%. Main causes of mortality in 2022 were prematurity (45%), perinatal asphyxia (21%) and sepsis (20%). To tackle this problem we performed an initial mortality analysis and used it to develop a workplan, which was then implemented during March – April 2023. The plan focused on improving compliance with zero-separation practices and adherence to neonatal care protocols and on reducing nosocomial infection. Specific activities, among many, included ensuring enough space for mothers to stay with their newborns in the ward and implementing a breastfeeding group with weekly meetings. Here we present our assessment of whether and how these measures may have affected neonatal mortality.
METHODS
Inpatient mortality rates of pre- and post-implementation period were compared from aggregated monthly data in MSF ́s Health Management Information System (HMIS). We conducted analysis stratified by year and by predefined periods – pre-implementation periods: January to August 22 and September 22 to February 23 (reference period) and post- implementation period: May to December 23. Mortality rate ratios (MRR) were calculated using negative binomial regression adjusted for month of admission.
RESULTS
1050 neonatal deaths and 5733 exits were included in the analysis period. Our data showed a 24% decrease in overall neonatal mortality (MRR = 0.76, 95%CI 0.60-0.95, p=0.02) during the post-implementation period compared to the reference period, with the reduction affecting all three main causes of mortality equally (prematurity accounted for 46% of all deaths post-implementation, sepsis 21%, and perinatal asphyxia 20%). A significant decrease in mortality (26%) was seen in 2023 when compared to 2022 (MRR = 0.74, 95%CI 0.65-0.85, p<0.05).
CONCLUSIONS
Neonatal mortality is usually an important challenge in MSF settings. Here we describe some low-cost strategies that have likely contributed to reducing inpatient mortality. A comprehensive approach to neonatal care with involvement of locally-hired staff seems essential for good outcomes and continuity. This experience provides valuable insights for healthcare professionals working in similar settings.
Conference Material > Abstract
Bossard C, Payotte S, Scarpa G, Diallo AK, Lissouba P, et al.
MSF Paediatric Days 2024. 3 May 2024
BACKGROUND AND OBJECTIVES
Early psychosocial stimulation for infants in precarious situations can yield both short- and long-term benefits to cognitive and social development. Comprehensive programmes, covering health, nutrition, and psychosocial stimulation prove most effective in preventing cognitive impairment and enhancing treatment for children with severe acute malnutrition (SAM). The StimNut study assesses the effects of early psychosocial stimulation on maternal mental health and mother-child relationship, as well as the acceptability of integrating such an intervention into the existing Médecins Sans Frontières (MSF) nutrition programme in Koutiala, during a 5-week period.
METHODS
Mixed-methods data were collected through standardised pre- and post- intervention questionnaires and included: a ‘Dusukasi’ screening tool for local perinatal depression-like symptoms; observations of mother-child interactions using an adapted PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes) tool; as well as semi-structured interviews with caregivers, MSF psychosocial workers, and healthcare staff.
RESULTS
149 psychosocial stimulation sessions were conducted with 36 families by three supervised MSF psychosocial workers. Perinatal depression symptoms were found in 53% of mothers before the intervention and 28% after the intervention (p=0.001). Positive changes in the mother-child relationship were observed in 83% of families after the 5-week intervention and more frequent and appropriate responses of the caregivers to the child’s emotional state were noted. Positive changes were also perceived by the mothers as the sessions progressed: their sense of parenting skills was strengthened, their children’s health improved, and the other family members became more involved in childcare practices. The intervention also dismantled healthcare staff prejudices towards mothers of children with SAM, fostering a trusting relationship between them.
CONCLUSIONS
This study demonstrates the positive impact of the early psychosocial stimulation of children with SAM on maternal mental health and the quality of mother-child relationship. As MSF pursues further endeavours in this direction, it is important to recognise the transformative potential these interventions hold for promoting the overall wellbeing of families of children with SAM in humanitarian and low-income countries.
Early psychosocial stimulation for infants in precarious situations can yield both short- and long-term benefits to cognitive and social development. Comprehensive programmes, covering health, nutrition, and psychosocial stimulation prove most effective in preventing cognitive impairment and enhancing treatment for children with severe acute malnutrition (SAM). The StimNut study assesses the effects of early psychosocial stimulation on maternal mental health and mother-child relationship, as well as the acceptability of integrating such an intervention into the existing Médecins Sans Frontières (MSF) nutrition programme in Koutiala, during a 5-week period.
METHODS
Mixed-methods data were collected through standardised pre- and post- intervention questionnaires and included: a ‘Dusukasi’ screening tool for local perinatal depression-like symptoms; observations of mother-child interactions using an adapted PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes) tool; as well as semi-structured interviews with caregivers, MSF psychosocial workers, and healthcare staff.
RESULTS
149 psychosocial stimulation sessions were conducted with 36 families by three supervised MSF psychosocial workers. Perinatal depression symptoms were found in 53% of mothers before the intervention and 28% after the intervention (p=0.001). Positive changes in the mother-child relationship were observed in 83% of families after the 5-week intervention and more frequent and appropriate responses of the caregivers to the child’s emotional state were noted. Positive changes were also perceived by the mothers as the sessions progressed: their sense of parenting skills was strengthened, their children’s health improved, and the other family members became more involved in childcare practices. The intervention also dismantled healthcare staff prejudices towards mothers of children with SAM, fostering a trusting relationship between them.
CONCLUSIONS
This study demonstrates the positive impact of the early psychosocial stimulation of children with SAM on maternal mental health and the quality of mother-child relationship. As MSF pursues further endeavours in this direction, it is important to recognise the transformative potential these interventions hold for promoting the overall wellbeing of families of children with SAM in humanitarian and low-income countries.
Conference Material > Abstract
Haj-Hassan TA, Amer M, Al-Jubori K, Salim H, Hameed A, et al.
MSF Paediatric Days 2024. 3 May 2024
BACKGROUND AND OBJECTIVES
Continuous Positive Airway Pressure (CPAP) is recommended for neonates with respiratory distress. CPAP is widely used in high-income countries, but less so in low- and middle-income settings. Here we assess key aspects of implementing CPAP in a humanitarian setting and describe the initial cohort of neonates treated, along with their clinical outcomes.
METHODS
MSF implemented CPAP in a basic neonatal unit in Mosul following the request of the local medical team. Implementation of two bubble CPAP machines included initial training and refresher training one year later. Clinical data was recorded over 16 months (13 April 2021- 21 July 2022). Descriptive statistics were used to assess the feasibility and outcomes of using CPAP in this setting.
RESULTS
CPAP was well accepted by most healthcare workers and parents. 93 neonates were placed on CPAP. 98% of patients had a birthweight >1.5Kg. The main indications were respiratory distress syndrome, pneumonia, transient tachypnoea, and meconium aspiration (46%, 22%, 16%, and 14% respectively). Average duration on CPAP was 53 hours. 63% of patients recovered, 8% were discharged against medical advice, 9% were referred, and 15% died. Among the 15 patients who died at our facility or at the referral facility, 7 had a contraindication to CPAP, and the initiation of CPAP was delayed in 9 patients. Complications included minor nasal lesions (17%), irritability (8%), and pneumothoraces (5%).
DISCUSSION
Most patients improved with CPAP and were discharged home. 5% of patients developed pneumothoraces, which is in keeping with other reports. However, among patients who did not improve, a significant proportion had contraindications to CPAP initiation and/or were placed on CPAP in extremis, highlighting the importance of clear indication criteria and training. Using CPAP in a humanitarian setting may be feasible but is associated with high human resource needs for both training and practice.
Continuous Positive Airway Pressure (CPAP) is recommended for neonates with respiratory distress. CPAP is widely used in high-income countries, but less so in low- and middle-income settings. Here we assess key aspects of implementing CPAP in a humanitarian setting and describe the initial cohort of neonates treated, along with their clinical outcomes.
METHODS
MSF implemented CPAP in a basic neonatal unit in Mosul following the request of the local medical team. Implementation of two bubble CPAP machines included initial training and refresher training one year later. Clinical data was recorded over 16 months (13 April 2021- 21 July 2022). Descriptive statistics were used to assess the feasibility and outcomes of using CPAP in this setting.
RESULTS
CPAP was well accepted by most healthcare workers and parents. 93 neonates were placed on CPAP. 98% of patients had a birthweight >1.5Kg. The main indications were respiratory distress syndrome, pneumonia, transient tachypnoea, and meconium aspiration (46%, 22%, 16%, and 14% respectively). Average duration on CPAP was 53 hours. 63% of patients recovered, 8% were discharged against medical advice, 9% were referred, and 15% died. Among the 15 patients who died at our facility or at the referral facility, 7 had a contraindication to CPAP, and the initiation of CPAP was delayed in 9 patients. Complications included minor nasal lesions (17%), irritability (8%), and pneumothoraces (5%).
DISCUSSION
Most patients improved with CPAP and were discharged home. 5% of patients developed pneumothoraces, which is in keeping with other reports. However, among patients who did not improve, a significant proportion had contraindications to CPAP initiation and/or were placed on CPAP in extremis, highlighting the importance of clear indication criteria and training. Using CPAP in a humanitarian setting may be feasible but is associated with high human resource needs for both training and practice.
Conference Material > Abstract
Lau DK, Seebacher S, Abdi AM, Bishar S, Nur MB, et al.
MSF Paediatric Days 2024. 3 May 2024
BACKGROUND AND OBJECTIVES
Kismayo is a city in southern Somalia and the capital of Jubaland State. In 2020, the Jubaland State Ministry of Health (MoH) recorded 1094 measles cases: an 8.2-fold increase from 2019. This study sought to estimate measles disease burden and measles vaccination coverage during the 2020-2021 outbreak, while further identifying key barriers and facilitators to measles vaccination and care.
METHODS
We utilised a sequential mixed-method approach with two phases of data collection. Phase one involved a cross-sectional household survey with a standard questionnaire while phase two included key informant interviews and focus group discussions with community members, health care workers and vaccination program administrators.
RESULTS
Of 6664 individuals, 338 measles cases were recorded during the two-year recall period, giving an attack rate of 5% (95%CI:4-5). 17 measles deaths were reported, giving a case fatality ratio of 4% (95%CI:2-6). Measles-specific mortality was 0.04 deaths/day/10000 population (95%CI:0.02-0.05). Initially, 50% of vaccine-eligible children had one or more doses of measles containing vaccine (MCV) and this rose to 69% by the end of the recall period. Thematic analysis led to the grouping of qualitative data into two overarching themes: sociocultural factors and health system factors. Regarding sociocultural factors, respondents gave insights on community measles knowledge and care practices, social responsibility for prevention, security challenges and measles-related rumours. Regarding health system factors, respondents spoke about challenges with health service management and shortcomings in the implementation of the expanded programme on immunisation (EPI) and mass vaccination campaigns.
CONCLUSIONS
Our results show that measles represents a serious health burden for the Kismayo population and that MCV coverage is well below the 95% target for herd immunity. We recommend developing a population-specific approach to risk communication and community engagement, expanding measles care, increasing accessibility for EPI services in health facilities and mobile clinics, and developing improved programmatic strategies for mass vaccination campaigns.
Kismayo is a city in southern Somalia and the capital of Jubaland State. In 2020, the Jubaland State Ministry of Health (MoH) recorded 1094 measles cases: an 8.2-fold increase from 2019. This study sought to estimate measles disease burden and measles vaccination coverage during the 2020-2021 outbreak, while further identifying key barriers and facilitators to measles vaccination and care.
METHODS
We utilised a sequential mixed-method approach with two phases of data collection. Phase one involved a cross-sectional household survey with a standard questionnaire while phase two included key informant interviews and focus group discussions with community members, health care workers and vaccination program administrators.
RESULTS
Of 6664 individuals, 338 measles cases were recorded during the two-year recall period, giving an attack rate of 5% (95%CI:4-5). 17 measles deaths were reported, giving a case fatality ratio of 4% (95%CI:2-6). Measles-specific mortality was 0.04 deaths/day/10000 population (95%CI:0.02-0.05). Initially, 50% of vaccine-eligible children had one or more doses of measles containing vaccine (MCV) and this rose to 69% by the end of the recall period. Thematic analysis led to the grouping of qualitative data into two overarching themes: sociocultural factors and health system factors. Regarding sociocultural factors, respondents gave insights on community measles knowledge and care practices, social responsibility for prevention, security challenges and measles-related rumours. Regarding health system factors, respondents spoke about challenges with health service management and shortcomings in the implementation of the expanded programme on immunisation (EPI) and mass vaccination campaigns.
CONCLUSIONS
Our results show that measles represents a serious health burden for the Kismayo population and that MCV coverage is well below the 95% target for herd immunity. We recommend developing a population-specific approach to risk communication and community engagement, expanding measles care, increasing accessibility for EPI services in health facilities and mobile clinics, and developing improved programmatic strategies for mass vaccination campaigns.
Conference Material > Abstract
Ostrowski JJ, Parikh K, Umar A
MSF Paediatric Days 2024. 3 May 2024
BACKGROUND AND OBJECTIVES
Over 50,000 children in Nigeria’s Gombe state have moderate acute malnutrition (MAM) and are at risk of deteriorating to severe acute malnutrition (SAM). An effective strategy to reduce mortality is through a targeted supplementary feeding programme delivered within community-based management of acute malnutrition (CMAM) interventions. We present findings from an outpatient therapeutic programme (OTP) which used Tom Brown for treating children with MAM. Tom Brown is a locally produced flour blend of sorghum, soybeans, and groundnuts, consumed as a sweetened porridge.
METHODS
We conducted retrospective analysis of patient data from OTP sites in three local government areas between October 2022 and December 2023. Data were extracted for children aged 6-59 months diagnosed with MAM, defined as absence of oedema; weight-for- height z-score (WHZ) ≥-3 and <-2; and/or mid upper arm circumference (MUAC) ≥11.5 and <12.5 cm. Those enrolled for at least 14 days and receiving 1.5 kg per week of Tom Brown were included.
RESULTS
Of the 1,207 cases of MAM treated, 1,089 (90.2%) recovered i.e. had two consecutive visits with WHZ >-2 and MUAC >12.5 and no severe clinical complications; 91 (7.5%) defaulted; 21 (1.7%) did not improve; 4 (<1%) were transferred out; and 2 (<1%) died at the end of follow- up. During treatment, 197 (16.3%) deteriorated to SAM and were switched to ready-to-use therapeutic food. All deaths (n=2) deteriorated to SAM. For children who recovered without deterioration, average enrolment length was 36.3 (±15.8) days and average weight gain was 4.21 (±3.03) g/kg/day.
CONCLUSIONS
With acceptable recovery and low death rates, Tom Brown is a feasible alternative for treatment of MAM. Made with cheaper ingredients, it can potentially reach more children for the same cost, particularly when combined with frequent screening and early diagnosis in the community. Timely follow-up of defaulters may also improve adherence. Research is needed to understand Tom Brown’s effectiveness compared to commercial products or combination with cash-based assistance.
Over 50,000 children in Nigeria’s Gombe state have moderate acute malnutrition (MAM) and are at risk of deteriorating to severe acute malnutrition (SAM). An effective strategy to reduce mortality is through a targeted supplementary feeding programme delivered within community-based management of acute malnutrition (CMAM) interventions. We present findings from an outpatient therapeutic programme (OTP) which used Tom Brown for treating children with MAM. Tom Brown is a locally produced flour blend of sorghum, soybeans, and groundnuts, consumed as a sweetened porridge.
METHODS
We conducted retrospective analysis of patient data from OTP sites in three local government areas between October 2022 and December 2023. Data were extracted for children aged 6-59 months diagnosed with MAM, defined as absence of oedema; weight-for- height z-score (WHZ) ≥-3 and <-2; and/or mid upper arm circumference (MUAC) ≥11.5 and <12.5 cm. Those enrolled for at least 14 days and receiving 1.5 kg per week of Tom Brown were included.
RESULTS
Of the 1,207 cases of MAM treated, 1,089 (90.2%) recovered i.e. had two consecutive visits with WHZ >-2 and MUAC >12.5 and no severe clinical complications; 91 (7.5%) defaulted; 21 (1.7%) did not improve; 4 (<1%) were transferred out; and 2 (<1%) died at the end of follow- up. During treatment, 197 (16.3%) deteriorated to SAM and were switched to ready-to-use therapeutic food. All deaths (n=2) deteriorated to SAM. For children who recovered without deterioration, average enrolment length was 36.3 (±15.8) days and average weight gain was 4.21 (±3.03) g/kg/day.
CONCLUSIONS
With acceptable recovery and low death rates, Tom Brown is a feasible alternative for treatment of MAM. Made with cheaper ingredients, it can potentially reach more children for the same cost, particularly when combined with frequent screening and early diagnosis in the community. Timely follow-up of defaulters may also improve adherence. Research is needed to understand Tom Brown’s effectiveness compared to commercial products or combination with cash-based assistance.
Conference Material > Abstract
Mbusa Kambale R, Ntagerwa Ntagazibwa J, Bwija Kasengi J, Burume Zigashane A, Nancy Francisca I, et al.
MSF Paediatric Days 2024. 3 May 2024
CONTEXTE
La malnutrition aigüe sévère (MAS) contribue annuellement au décès d’un million d’enfants. Les diarrhées et la pneumonie sont les principales morbidités associées à ces décès.
OBJECTIFS
Évaluer les effets des probiotiques sur la diarrhée, la pneumonie et la récupération nutritionnelle des enfants avec MAS non compliquée.
METHODS
Essai randomisé contrôlé en double aveugle contre placebo incluant 400 nourrissons avec MAS non compliquée, assignés aléatoirement aux Aliments Thérapeutiques Prêts à l'Emploi (ATPE) avec (n=200) ou sans (n=200) probiotiques. Ils ont reçu quotidiennement 1 ml d'un mélange de Lacticasebacillus rhamnosus GG et Limosilactobacillus reuteri DSM 17938 (dosage, 109 Unités Formant Colonies ; 50:50) ou un placebo pendant un mois. Ils ont aussi été alimentés simultanément avec les ATPE pendant 6-12 semaines, dépendant de leur moment de guérison. Le résultat primaire était la durée de diarrhée. Les résultats secondaires étaient l'incidence des diarrhées et des pneumonies, la récupération nutritionnelle et le transfert en hospitalisation.
RÉSULTATS
Chez les nourrissons avec diarrhée, le nombre de jours de diarrhées était plus faible dans le groupe probiotique (4.11 ; IC 95% : 3.37, 4.51) comparativement au groupe placebo (6.68 ; IC à 95 % : 6.26, 7.13 ; p < 0.001). Chez les nourrissons de 16 mois et plus, le risque de diarrhée était plus faible dans le groupe probiotique (75.6 % ; IC 95 % : 66.2, 82.9) comparativement au groupe placebo (95.0 % ; IC 95 % : 88.2, 97.9 ; p < 0.001), sans différence significative chez les nourrissons plus jeunes. L’incidence de la pneumonie était similaire dans les deux groupes. La récupération nutritionnelle était plus précoce dans le groupe probiotique comparativement au groupe placebo.
CONCLUSIONS
Cet essai soutient l'utilisation des probiotiques dans le traitement de MAS non compliquée. Leurs effets sur la diarrhée ont un potentiel d’impact positif sur les programmes nutritionnels dans les régions à ressources limitées.
La malnutrition aigüe sévère (MAS) contribue annuellement au décès d’un million d’enfants. Les diarrhées et la pneumonie sont les principales morbidités associées à ces décès.
OBJECTIFS
Évaluer les effets des probiotiques sur la diarrhée, la pneumonie et la récupération nutritionnelle des enfants avec MAS non compliquée.
METHODS
Essai randomisé contrôlé en double aveugle contre placebo incluant 400 nourrissons avec MAS non compliquée, assignés aléatoirement aux Aliments Thérapeutiques Prêts à l'Emploi (ATPE) avec (n=200) ou sans (n=200) probiotiques. Ils ont reçu quotidiennement 1 ml d'un mélange de Lacticasebacillus rhamnosus GG et Limosilactobacillus reuteri DSM 17938 (dosage, 109 Unités Formant Colonies ; 50:50) ou un placebo pendant un mois. Ils ont aussi été alimentés simultanément avec les ATPE pendant 6-12 semaines, dépendant de leur moment de guérison. Le résultat primaire était la durée de diarrhée. Les résultats secondaires étaient l'incidence des diarrhées et des pneumonies, la récupération nutritionnelle et le transfert en hospitalisation.
RÉSULTATS
Chez les nourrissons avec diarrhée, le nombre de jours de diarrhées était plus faible dans le groupe probiotique (4.11 ; IC 95% : 3.37, 4.51) comparativement au groupe placebo (6.68 ; IC à 95 % : 6.26, 7.13 ; p < 0.001). Chez les nourrissons de 16 mois et plus, le risque de diarrhée était plus faible dans le groupe probiotique (75.6 % ; IC 95 % : 66.2, 82.9) comparativement au groupe placebo (95.0 % ; IC 95 % : 88.2, 97.9 ; p < 0.001), sans différence significative chez les nourrissons plus jeunes. L’incidence de la pneumonie était similaire dans les deux groupes. La récupération nutritionnelle était plus précoce dans le groupe probiotique comparativement au groupe placebo.
CONCLUSIONS
Cet essai soutient l'utilisation des probiotiques dans le traitement de MAS non compliquée. Leurs effets sur la diarrhée ont un potentiel d’impact positif sur les programmes nutritionnels dans les régions à ressources limitées.
Conference Material > Abstract
Shyaka A, Kabongo F, Tolno C, Barry I, Bachy C
MSF Paediatric Days 2024. 3 May 2024
CONTEXTE ET OBJECTIFS
Les épidémies de maladies évitables par la vaccination sont récurrentes en Guinée. En 2020, Matoto a enregistré 86% des cas de rougeole rapportés à Conakry. Cette étude avait pour objectif d’évaluer les occasions manquées de vaccination chez les enfants de 0-59 mois.
METHODES
Il s’agissait d’une étude transversale par entretien de sortie dans quatre établissements de santé (ES) de Matoto (Bernay Fotoba, Saint Gabriel, Tombolia, Dabompa) du 11-19 avril 2023. A été considéré comme OMV, tout enfant qui n'avait pas reçu les vaccins indiqués à l’issue de sa visite même s'il avait dépassé l'âge recommandé pour les recevoir selon la politique du pays.
Un échantillon de convenance par défaut a été utilisé avec au minimum, 100 enfants sélectionnés (50 âgés de 0-23 mois et 50 âgés de 24-59 mois) dans chaque ES. Les données ont été recueillies à l'aide d’un questionnaire anonyme standardisé MSF puis saisies dans une base de données Excel développé par MSF où les indicateurs ont été calculés automatiquement. Cette évaluation a reçu les approbations du comité national d’éthique et du comité d’éthique de MSF.
RESULTATS
Sur 357 enfants (0-23 mois=182 ; 24-59 mois=175) éligibles pour une vaccination, 300 ont présenté une OMV soit une prévalence des OMV de 84% (300/357). Parmi les enfants avec OMV, 53% (159/300) avait 24-59 mois. Ceux de 0-23 mois, cible du PEV, représentaient 47% (141/300). Le vaccin antirougeoleux (56%) et le vaccin antipoliomyélitique oral (50%) ont été les plus manqués. Nous notons que 41% (124/300) des enfants avec OMV étaient présents dans ces ES pour une vaccination. Le manque d’information (47%) et les ruptures de vaccins (38%) étaient les principales raisons invoquées par les participants pour justifier les OMV.
CONCLUSIONS
Nos résultats montrent la nécessité d’intégrer l’évaluation des OMV dans le système de santé en tant que processus de routine et d’assurer un approvisionnement constant et suffisant en vaccins et matériel de vaccination.
Conference Material > Abstract
Traore-Hebie M, Nasira Boi A, Poni Jackson M, Sasa N, Wendo D, et al.
MSF Paediatric Days 2024. 3 May 2024
BACKGROUND AND OBJECTIVES
Globally, one in four infants is born too small or too early and is therefore at increased risk of poor growth and development, ill-health and death. In South Sudan, vulnerability is further exacerbated by recurring conflict and climatic shocks. Five primary healthcare facilities across four States introduced the integrated care pathway (ICP) for small and nutritionally at-risk infants and their mothers (MAMI), ensuring continuity of mother-infant-centred care. This study explored the acceptability of the ICP among care providers and care users.
METHODS
A mixed-method study followed a cohort of 521 infant-mother pairs at moderate risk from October 2022 to December 2023 until the infant reached 6 months. The ICP involved screening for vulnerability in both the community and health facility, assessing and classifying risk, and tailoring care to address physical health, mental health, nutritional and socio- economic factors of both infants and their mothers. Acceptability and adherence of the ICP was appraised based on experienced cognitive, socio-economic, and emotional responses from 20 health workers and 30 enrolled mothers interviewed.
RESULTS
Most of the 521 moderate-risk pairs receiving care (84%) no longer showed risk factors (defined as recovered) at the end of care. Mothers’ adherence to returning for scheduled follow-up visits was low (56%). Facilitators included improved care for their infant, facilitated access to healthcare, supportive environment for adopting healthy behaviours. Barriers included not understanding vulnerability and health monitoring, long waiting time at the health facility, not receiving tangible items compared to other services, transportation challenges and conflicting messages within the healthcare system and from the family context. Among health workers, the acceptability of the ICP was enabled by early care for a neglected population and hampered by more and longer consultations not part of regular duties using lengthy assessment forms. The collaborative learning system engaged health workers in improving quality of care, adapting implementation modalities to the local health system, and addressing barriers early.
CONCLUSIONS
Collective adaptive learning on implementing the ICP contributed to understanding barriers to implementation and addressing risk factors for vulnerable infants and their mothers early. Context-specific and generalizable learning will inform policy guidance.
Globally, one in four infants is born too small or too early and is therefore at increased risk of poor growth and development, ill-health and death. In South Sudan, vulnerability is further exacerbated by recurring conflict and climatic shocks. Five primary healthcare facilities across four States introduced the integrated care pathway (ICP) for small and nutritionally at-risk infants and their mothers (MAMI), ensuring continuity of mother-infant-centred care. This study explored the acceptability of the ICP among care providers and care users.
METHODS
A mixed-method study followed a cohort of 521 infant-mother pairs at moderate risk from October 2022 to December 2023 until the infant reached 6 months. The ICP involved screening for vulnerability in both the community and health facility, assessing and classifying risk, and tailoring care to address physical health, mental health, nutritional and socio- economic factors of both infants and their mothers. Acceptability and adherence of the ICP was appraised based on experienced cognitive, socio-economic, and emotional responses from 20 health workers and 30 enrolled mothers interviewed.
RESULTS
Most of the 521 moderate-risk pairs receiving care (84%) no longer showed risk factors (defined as recovered) at the end of care. Mothers’ adherence to returning for scheduled follow-up visits was low (56%). Facilitators included improved care for their infant, facilitated access to healthcare, supportive environment for adopting healthy behaviours. Barriers included not understanding vulnerability and health monitoring, long waiting time at the health facility, not receiving tangible items compared to other services, transportation challenges and conflicting messages within the healthcare system and from the family context. Among health workers, the acceptability of the ICP was enabled by early care for a neglected population and hampered by more and longer consultations not part of regular duties using lengthy assessment forms. The collaborative learning system engaged health workers in improving quality of care, adapting implementation modalities to the local health system, and addressing barriers early.
CONCLUSIONS
Collective adaptive learning on implementing the ICP contributed to understanding barriers to implementation and addressing risk factors for vulnerable infants and their mothers early. Context-specific and generalizable learning will inform policy guidance.
Conference Material > Abstract
Juma H, Worku DT, Evboumwan PE, Katuala Y, Mbuyi Y, et al.
MSF Paediatric Days 2024. 3 May 2024
BACKGROUND AND OBJECTIVES
Diphtheria is a vaccine preventable disease caused by toxicogenic Corynebacterium diphtheriae. Since declaration of an outbreak in Nigeria in December 2022, Kano state has been its epicentre, with 77% of the 12,581 confirmed cases nationally. In response, a Decentralised Model of Care (DMC) for delivering proximal, fast, and easily accessible curative and preventive community-based health care was introduced in Kano. Here, we describe implementation of this DMC and assess its impact in reducing mortality from diphtheria during this outbreak.
METHODS
Components of DMC:
• OPD for the triaging and management of mild cases
• Contact clinic (mobile and fixed) to improve access to preventative care for close contacts
Main packages of DMC:
• Health and Infection Prevention and Control promotion
• Chemoprophylaxis and vaccination for close contacts
• Identification and management of simple cases
• Referral of complicated cases
• Training of health workers
DMC was implemented within existing public health facilities for outpatient services, and in the community for the management of close contacts. The selection of facilities was guided by epidemiological data analysis and mapping.
Chi-square testing was used for analysing statistical significance on mortality before and after the implementation of DMC.
RESULTS
Between weeks 2 and 48 of 2023, the health facilities included in this study managed a total of 12,662 suspected diphtheria cases. From this, 1,987 cases (136 deaths; CFR 6.84%) were managed before implementation of DMC (before week 34), and 10,675 cases (611 deaths; CFR 5.72%) were managed after its implementation (from week 34 to 48). One-tailed Chi-square testing showed a statistically significant difference in mortality before and after implementation (p-value 0.02).
CONCLUSIONS
DMC may have contributed to the reduction of mortality in healthcare facilities. Upon in-depth analysis of the impact of DMC, it may be recommended for implementation in large outbreaks. Further studies, however, need to be conducted to assess the role of DMC in improving patients’ access to healthcare and reducing the burden on healthcare facilities during massive outbreaks.
Diphtheria is a vaccine preventable disease caused by toxicogenic Corynebacterium diphtheriae. Since declaration of an outbreak in Nigeria in December 2022, Kano state has been its epicentre, with 77% of the 12,581 confirmed cases nationally. In response, a Decentralised Model of Care (DMC) for delivering proximal, fast, and easily accessible curative and preventive community-based health care was introduced in Kano. Here, we describe implementation of this DMC and assess its impact in reducing mortality from diphtheria during this outbreak.
METHODS
Components of DMC:
• OPD for the triaging and management of mild cases
• Contact clinic (mobile and fixed) to improve access to preventative care for close contacts
Main packages of DMC:
• Health and Infection Prevention and Control promotion
• Chemoprophylaxis and vaccination for close contacts
• Identification and management of simple cases
• Referral of complicated cases
• Training of health workers
DMC was implemented within existing public health facilities for outpatient services, and in the community for the management of close contacts. The selection of facilities was guided by epidemiological data analysis and mapping.
Chi-square testing was used for analysing statistical significance on mortality before and after the implementation of DMC.
RESULTS
Between weeks 2 and 48 of 2023, the health facilities included in this study managed a total of 12,662 suspected diphtheria cases. From this, 1,987 cases (136 deaths; CFR 6.84%) were managed before implementation of DMC (before week 34), and 10,675 cases (611 deaths; CFR 5.72%) were managed after its implementation (from week 34 to 48). One-tailed Chi-square testing showed a statistically significant difference in mortality before and after implementation (p-value 0.02).
CONCLUSIONS
DMC may have contributed to the reduction of mortality in healthcare facilities. Upon in-depth analysis of the impact of DMC, it may be recommended for implementation in large outbreaks. Further studies, however, need to be conducted to assess the role of DMC in improving patients’ access to healthcare and reducing the burden on healthcare facilities during massive outbreaks.
