Conference Material > Slide Presentation
Formation virtuelle comme catalyseur d’amelioration des soins neonataux au CSREF de Douentza / Mali
Rubona F, Ibongu E, Bah AJ, Dianouni F, Wepnyui H
MSF Paediatric Days 2024. 2024 May 4; DOI:10.57740/rleZ6pb8
Français
Conference Material > Slide Presentation
Bossard C, Payotte S, Scarpa G, Diallo AK, Lissouba P, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/hbFEFb2
Journal Article > ResearchFull Text
Int J Infect Dis. 2022 September 1; Volume 122; 215-221.; DOI:10.1016/j.ijid.2022.05.039
Zheng Q, Luquero FJ, Ciglenecki I, Wamala JF, Abubakar A, et al.
Int J Infect Dis. 2022 September 1; Volume 122; 215-221.; DOI:10.1016/j.ijid.2022.05.039
BACKGROUND
Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology.
METHODS
From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics.
RESULTS
We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks.
CONCLUSIONS
This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology.
METHODS
From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics.
RESULTS
We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks.
CONCLUSIONS
This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Conference Material > Abstract
Diallo AK, Bossard C
Epicentre Scientific Day Paris 2023. 2023 June 8
BACKGROUND AND AIMS
Early psychosocial stimulation with disadvantaged infants can lead to short- and long-term benefits in cognitive and social development. Programs with multiple
components, including health, nutrition, and psychosocial stimulation have shown to be the most successful at enhancing the rehabilitation of severe acute malnourished (SAM) children. The STIMNUT study assesses the feasibility of integrating an adapted version of the ‘Follow-Up of Severe Acute Malnourished children’ (FUSAM) protocol developed by Action Contre la Faim into the Médecins Sans Frontières (MSF) Therapeutic Feeding Programme in Koutiala (Mali) for SAM children aged 6-23 months and their primary caregivers.
METHODS
A convergent mixed methods study was implemented between July 2022 and May 2023 in two outpatient health facilities and the general hospital in Koutiala. An adaptation of the PRECEDE-PROCEED conceptual framework was used to adapt, implement and evaluate the psychosocial stimulation intervention. The study was
divided into 3 successive phases: (1) a mixed methods initial assessment at community level, (2) the contextual adaptation of the FUSAM protocol through a participatory approach (PAR) and (3) an assessment of its acceptability. For this assessment, 15 individual interviews with mothers were conducted. Qualitative and quantitative data were analyzed and interpreted concurrently.
RESULTS
During the PAR process, various stakeholders including, development workers and health professionals, parents of SAM children and traditional healers, worked together to practically adapt the intervention. They proposed for instance to include a community-level ceremony at the beginning of the intervention with traditional authorities, villages chiefs and other local stakeholders to increase its appropriation and to sensitize community members. During phase 3, a total of 149 psychosocial stimulation sessions (122 individual and 27 collective) were delivered by a team of 3 psychosocial workers to the 36 families included. The preliminary acceptability results showed that the sessions were well appreciated by the mothers. They became more acceptable as the intervention progressed because of the resulting positive changes in their children’s wellbeing, in theirs and their families’ relationship with their children, and in the mothers' relationships with their husbands and extended family.
CONCLUSION
The implementation of the adapted version of FUSAM protocol and its acceptability assessment at primary and secondary health care levels will now be used to inform the further deployment of the intervention. In particular, the results have allowed the development of a framework for the StimNut intervention to make it locally relevant and to guide its reproducibility in other contexts.
KEY MESSAGE
StimNut is a mixed method feasibility study on the integration of a psychosocial stimulation intervention into the standard nutritional care for SAM children aged 6-23 months In Koutiala, Mali.
This abstract is not to be quoted for publication.
Early psychosocial stimulation with disadvantaged infants can lead to short- and long-term benefits in cognitive and social development. Programs with multiple
components, including health, nutrition, and psychosocial stimulation have shown to be the most successful at enhancing the rehabilitation of severe acute malnourished (SAM) children. The STIMNUT study assesses the feasibility of integrating an adapted version of the ‘Follow-Up of Severe Acute Malnourished children’ (FUSAM) protocol developed by Action Contre la Faim into the Médecins Sans Frontières (MSF) Therapeutic Feeding Programme in Koutiala (Mali) for SAM children aged 6-23 months and their primary caregivers.
METHODS
A convergent mixed methods study was implemented between July 2022 and May 2023 in two outpatient health facilities and the general hospital in Koutiala. An adaptation of the PRECEDE-PROCEED conceptual framework was used to adapt, implement and evaluate the psychosocial stimulation intervention. The study was
divided into 3 successive phases: (1) a mixed methods initial assessment at community level, (2) the contextual adaptation of the FUSAM protocol through a participatory approach (PAR) and (3) an assessment of its acceptability. For this assessment, 15 individual interviews with mothers were conducted. Qualitative and quantitative data were analyzed and interpreted concurrently.
RESULTS
During the PAR process, various stakeholders including, development workers and health professionals, parents of SAM children and traditional healers, worked together to practically adapt the intervention. They proposed for instance to include a community-level ceremony at the beginning of the intervention with traditional authorities, villages chiefs and other local stakeholders to increase its appropriation and to sensitize community members. During phase 3, a total of 149 psychosocial stimulation sessions (122 individual and 27 collective) were delivered by a team of 3 psychosocial workers to the 36 families included. The preliminary acceptability results showed that the sessions were well appreciated by the mothers. They became more acceptable as the intervention progressed because of the resulting positive changes in their children’s wellbeing, in theirs and their families’ relationship with their children, and in the mothers' relationships with their husbands and extended family.
CONCLUSION
The implementation of the adapted version of FUSAM protocol and its acceptability assessment at primary and secondary health care levels will now be used to inform the further deployment of the intervention. In particular, the results have allowed the development of a framework for the StimNut intervention to make it locally relevant and to guide its reproducibility in other contexts.
KEY MESSAGE
StimNut is a mixed method feasibility study on the integration of a psychosocial stimulation intervention into the standard nutritional care for SAM children aged 6-23 months In Koutiala, Mali.
This abstract is not to be quoted for publication.
Journal Article > Meta-AnalysisFull Text
Malar J. 2009 August 23; Volume 8 (Issue 1); 203.; DOI:10.1186/1475-2875-8-203
Zwang J, Olliaro PL, Barennes H, Bonnet MMB, Brasseur P, et al.
Malar J. 2009 August 23; Volume 8 (Issue 1); 203.; DOI:10.1186/1475-2875-8-203
BACKGROUND: Artesunate and amodiaquine (AS&AQ) is at present the world's second most widely used artemisinin-based combination therapy (ACT). It was necessary to evaluate the efficacy of ACT, recently adopted by the World Health Organization (WHO) and deployed over 80 countries, in order to make an evidence-based drug policy.
METHODS: An individual patient data (IPD) analysis was conducted on efficacy outcomes in 26 clinical studies in sub-Saharan Africa using the WHO protocol with similar primary and secondary endpoints.
RESULTS: A total of 11,700 patients (75% under 5 years old), from 33 different sites in 16 countries were followed for 28 days. Loss to follow-up was 4.9% (575/11,700). AS&AQ was given to 5,897 patients. Of these, 82% (4,826/5,897) were included in randomized comparative trials with polymerase chain reaction (PCR) genotyping results and compared to 5,413 patients (half receiving an ACT). AS&AQ and other ACT comparators resulted in rapid clearance of fever and parasitaemia, superior to non-ACT. Using survival analysis on a modified intent-to-treat population, the Day 28 PCR-adjusted efficacy of AS&AQ was greater than 90% (the WHO cut-off) in 11/16 countries. In randomized comparative trials (n = 22), the crude efficacy of AS&AQ was 75.9% (95% CI 74.6-77.1) and the PCR-adjusted efficacy was 93.9% (95% CI 93.2-94.5). The risk (weighted by site) of failure PCR-adjusted of AS&AQ was significantly inferior to non-ACT, superior to dihydroartemisinin-piperaquine (DP, in one Ugandan site), and not different from AS+SP or AL (artemether-lumefantrine). The risk of gametocyte appearance and the carriage rate of AS&AQ was only greater in one Ugandan site compared to AL and DP, and lower compared to non-ACT (p = 0.001, for all comparisons). Anaemia recovery was not different than comparator groups, except in one site in Rwanda where the patients in the DP group had a slower recovery.
CONCLUSION: AS&AQ compares well to other treatments and meets the WHO efficacy criteria for use against falciparum malaria in many, but not all, the sub-Saharan African countries where it was studied. Efficacy varies between and within countries. An IPD analysis can inform general and local treatment policies. Ongoing monitoring evaluation is required.
METHODS: An individual patient data (IPD) analysis was conducted on efficacy outcomes in 26 clinical studies in sub-Saharan Africa using the WHO protocol with similar primary and secondary endpoints.
RESULTS: A total of 11,700 patients (75% under 5 years old), from 33 different sites in 16 countries were followed for 28 days. Loss to follow-up was 4.9% (575/11,700). AS&AQ was given to 5,897 patients. Of these, 82% (4,826/5,897) were included in randomized comparative trials with polymerase chain reaction (PCR) genotyping results and compared to 5,413 patients (half receiving an ACT). AS&AQ and other ACT comparators resulted in rapid clearance of fever and parasitaemia, superior to non-ACT. Using survival analysis on a modified intent-to-treat population, the Day 28 PCR-adjusted efficacy of AS&AQ was greater than 90% (the WHO cut-off) in 11/16 countries. In randomized comparative trials (n = 22), the crude efficacy of AS&AQ was 75.9% (95% CI 74.6-77.1) and the PCR-adjusted efficacy was 93.9% (95% CI 93.2-94.5). The risk (weighted by site) of failure PCR-adjusted of AS&AQ was significantly inferior to non-ACT, superior to dihydroartemisinin-piperaquine (DP, in one Ugandan site), and not different from AS+SP or AL (artemether-lumefantrine). The risk of gametocyte appearance and the carriage rate of AS&AQ was only greater in one Ugandan site compared to AL and DP, and lower compared to non-ACT (p = 0.001, for all comparisons). Anaemia recovery was not different than comparator groups, except in one site in Rwanda where the patients in the DP group had a slower recovery.
CONCLUSION: AS&AQ compares well to other treatments and meets the WHO efficacy criteria for use against falciparum malaria in many, but not all, the sub-Saharan African countries where it was studied. Efficacy varies between and within countries. An IPD analysis can inform general and local treatment policies. Ongoing monitoring evaluation is required.
Conference Material > Abstract
Rieux C, Koudika MH
Epicentre Scientific Day Paris 2021. 2021 June 10
The emergence of chronic communicable diseases is a new health issue facing resource-limited countries and the medical organizations working in them. Cancer in particular has the greatest inequalities in survival and epidemiological predictions are worrying. It is estimated that by 2040, the number of new cancer cases and deaths in the poorest countries will double and more than 1.2 million new cases are expected. In 2018, MSF OCP has decided to get involved in the fight against cancer by developing operational projects and investing in access to prevention, diagnosis and treatment.
In Mali, the oncology project, dedicated to cervical and breast cancers (representing 30% of cancers of both sexes), built in partnership with Malian colleagues and Ministry of Health, started at the end of 2018 with palliative care, then support for screening, histopathology laboratory and specific treatments (surgery, chemotherapy, radiotherapy). In 2020, MSF provided specific care for 542 patients (366 breast cancers and 176 cervical cancers) and performed 2828 palliative consultations and 3260 tumor wounds care.
This experience confirmed the lack of financial and geographical access to screening and care facilities leading to diagnoses at very advanced stages and the complexity of management and multidisciplinary care pathways. This type of project implies new ways of working for MSF: the development of a holistic and patient-centered approach, long-term projection and working in partnership with national actors and international experts. Research, an essential element, needs to be developed around several axes: epidemiological, therapeutic trials and the introduction and evaluation of technological tools to improve diagnosis and management such as telemedicine and artificial intelligence. Finally, the issues of access not only to treatment but also to diagnosis and prevention are one of the major added values that MSF could bring to the fight against cancer.
KEY MESSAGE: Cancer is one of the new challenges that MSF has decided to tackle and for which new ways of working and research are needed.
This abstract is not to be quoted for publication.
In Mali, the oncology project, dedicated to cervical and breast cancers (representing 30% of cancers of both sexes), built in partnership with Malian colleagues and Ministry of Health, started at the end of 2018 with palliative care, then support for screening, histopathology laboratory and specific treatments (surgery, chemotherapy, radiotherapy). In 2020, MSF provided specific care for 542 patients (366 breast cancers and 176 cervical cancers) and performed 2828 palliative consultations and 3260 tumor wounds care.
This experience confirmed the lack of financial and geographical access to screening and care facilities leading to diagnoses at very advanced stages and the complexity of management and multidisciplinary care pathways. This type of project implies new ways of working for MSF: the development of a holistic and patient-centered approach, long-term projection and working in partnership with national actors and international experts. Research, an essential element, needs to be developed around several axes: epidemiological, therapeutic trials and the introduction and evaluation of technological tools to improve diagnosis and management such as telemedicine and artificial intelligence. Finally, the issues of access not only to treatment but also to diagnosis and prevention are one of the major added values that MSF could bring to the fight against cancer.
KEY MESSAGE: Cancer is one of the new challenges that MSF has decided to tackle and for which new ways of working and research are needed.
This abstract is not to be quoted for publication.
Conference Material > Slide Presentation
Rapoud D, Cramer E, Al Asmar M, Sagara F, Ndiaye B, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/2acXDPpuix
Journal Article > Meta-AnalysisAbstract
J Acquir Immune Defic Syndr. 2013 June 14; Volume 64 (Issue 1); DOI:10.1097/QAI.0b013e31829f05ac
Bonner K, Mezochow A, Roberts TR, Ford NP, Cohn J
J Acquir Immune Defic Syndr. 2013 June 14; Volume 64 (Issue 1); DOI:10.1097/QAI.0b013e31829f05ac
Journal Article > ResearchAbstract
Int Health. 2011 May 19; Volume 3 (Issue 2); 91-100.; DOI:10.1016/j.inhe.2011.01.002
Ponsar F, Tayler-Smith K, Philips M, Gerard S, Van Herp M, et al.
Int Health. 2011 May 19; Volume 3 (Issue 2); 91-100.; DOI:10.1016/j.inhe.2011.01.002
Although user fees are a common form of healthcare financing in resource-poor countries, there is growing consensus that their use compromises health service utilisation and population health. Between 2003 and 2006, Médecins sans Frontières (MSF) conducted population-based surveys in Burundi, Sierra Leone, Democratic Republic of Congo, Chad, Haiti and Mali to determine the impact of user fees on healthcare-seeking behaviour and access. For general and disease-specific conditions, MSF also measured the impact of (i) reduced payment systems in Chad, Mali, Haiti and Burundi and (ii) user fee abolition for certain population groups in Burundi and Mali. User fees were found to result in low utilisation of public health facilities, exclusion from health care and exacerbation of impoverishment, forcing many to seek alternative care. Financial barriers affected 30-60% of people requiring health care. Exemption systems targeting vulnerable individuals proved ineffective, benefiting only 1-3.5% of populations. Alternative payment systems, requiring 'modest' fees from users (e.g. low flat fees), did not adequately improve coverage of essential health needs, especially for the poorest and most vulnerable. Conversely, user fee abolition for large population groups led to rapid increases in utilisation of health services and coverage of essential healthcare needs. Abolition of user fees appears crucial in helping to reduce existing barriers to health care. The challenge for health authorities and donor agencies is around working creatively to remove the fees while addressing the financial consequences of improved access and providing quality care.
Conference Material > Poster
Hedible GB, Neboua D, Peters Bokol L, Anago G, Zair Z, et al.
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/j4yx-es02