Conference Material > Abstract
Haider A, Finger F
Epicentre Scientific Day Paris 2021. 2021 June 10
In this presentation, we provide an overview of the evolution of the COVID-19 pandemic in Yemen and Afghanistan and describe the characteristics of patients seen selected MSF health facilities.
YEMEN
The true burden of the COVID-19 pandemic in Yemen is largely underestimated. The official surveillance data is limited to the southern governorates only. The country has experienced two waves so far and until May 31 2021, the total number of confirmed cases reported was 6 746 with 1 322 associated deaths. With limited testing capacity, PCR tests are spared for suspect cases presenting with severe symptoms only. MSF has been operating several COVID-19 projects in the southern and northern parts since the beginning of the pandemic. To date, MSF France has treated 2 138 COVID-19 patients. The in-hospital mortality was 30%. This presentation provides an overview of the evolution of the pandemic in Yemen and a description of patients seen at MSF health facilities.
AFGHANISTAN
Afghanistan is currently experiencing a third wave of COVID-19. To date (31 May 2021) a total of nearly 73 000 confirmed cases and 3 000 deaths have been reported. The PCR testing capacity remains limited, particularly outside the national capital, and the characteristics of suspected patients are poorly described. MSF has bee supporting the pandemic response in Herat, the regional capital of Western Afghanistan, by running a COVID-19 triage at the Herat Regional Hospital and through case management. To date, over 31 000 patients have been received at the triage, and, if required, oriented towards appropriate care. In addition, patient data collected at the triage facility are a valuable surveillance tool since they allow to follow epidemic trends and to describe patient characteristics. Here we give an update about the current situation in Afghanistan and Herat and describe the characteristics of patients through the three epidemic waves.
YEMEN
The true burden of the COVID-19 pandemic in Yemen is largely underestimated. The official surveillance data is limited to the southern governorates only. The country has experienced two waves so far and until May 31 2021, the total number of confirmed cases reported was 6 746 with 1 322 associated deaths. With limited testing capacity, PCR tests are spared for suspect cases presenting with severe symptoms only. MSF has been operating several COVID-19 projects in the southern and northern parts since the beginning of the pandemic. To date, MSF France has treated 2 138 COVID-19 patients. The in-hospital mortality was 30%. This presentation provides an overview of the evolution of the pandemic in Yemen and a description of patients seen at MSF health facilities.
AFGHANISTAN
Afghanistan is currently experiencing a third wave of COVID-19. To date (31 May 2021) a total of nearly 73 000 confirmed cases and 3 000 deaths have been reported. The PCR testing capacity remains limited, particularly outside the national capital, and the characteristics of suspected patients are poorly described. MSF has bee supporting the pandemic response in Herat, the regional capital of Western Afghanistan, by running a COVID-19 triage at the Herat Regional Hospital and through case management. To date, over 31 000 patients have been received at the triage, and, if required, oriented towards appropriate care. In addition, patient data collected at the triage facility are a valuable surveillance tool since they allow to follow epidemic trends and to describe patient characteristics. Here we give an update about the current situation in Afghanistan and Herat and describe the characteristics of patients through the three epidemic waves.
Conference Material > Poster
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/ahq9-t438
Conference Material > Poster
Chiopris G, Hilbig A, Crucitti T, Lim CAE, Abdo Z
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/mHkaHKgJNw
Conference Material > Slide Presentation
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 May 10; DOI:10.57740/74t1-zq11
Conference Material > Video
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 June 10; DOI:10.57740/z68q-6865
Conference Material > Video
Camacho A
Epicentre Scientific Day Paris 2018. 2018 June 7
Journal Article > ResearchFull Text
BMC Pregnancy Childbirth. 2021 January 7; Volume 21 (Issue 1); 36.; DOI:10.1186/s12884-020-03507-5
Obel J, Martin AIC, Mullahzada AW, Kremer R, Maaloe N
BMC Pregnancy Childbirth. 2021 January 7; Volume 21 (Issue 1); 36.; DOI:10.1186/s12884-020-03507-5
BACKGROUND
Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes.
METHODS
A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month.
RESULTS
Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume.
CONCLUSIONS
Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.
Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes.
METHODS
A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month.
RESULTS
Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume.
CONCLUSIONS
Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.
Journal Article > ResearchFull Text
Lancet Global Health. 2018 May 3; Volume 6 (Issue 6); DOI:10.1016/S2214-109X(18)30230-4
Camacho A, Bouhenia M, Alyusfi R, Alkohlani A, Naji MAM, et al.
Lancet Global Health. 2018 May 3; Volume 6 (Issue 6); DOI:10.1016/S2214-109X(18)30230-4
In war-torn Yemen, reports of confirmed cholera started in late September, 2016. The disease continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aimed to describe the key epidemiological features of this epidemic, including the drivers of cholera transmission during the outbreak.
Conference Material > Abstract
Camacho A
Epicentre Scientific Day Paris 2018. 2018 June 7
We modelled the plausible drivers of cholera transmission during the course of the outbreak in Yemen. We found a strong association between rainfall and the massive surge of cholera cases in May 2017.
BACKGROUND
In war-torn Yemen, reports of confirmed cholera started in late September 2016. Cholera continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aim to describe key epidemiological features of this epidemic, including the drivers that triggered the massive surge of cholera cases in May 2017.
METHODS
The Health Authorities of Yemen set up a national cholera surveillance system to collect information on suspected cholera cases presenting at health-facilities and MSF cholera treatment centres. We first conducted descriptive analyses at national and governorate levels. We reconstructed the changes in cholera transmission over time by estimating the instantaneous reproduction number, Rt. Finally, we estimated the association between rainfall and the daily cholera incidence during the increasing phase of the second epidemic wave, from April 15 to June 24 2017, by fitting a spatiotemporal regression model.
RESULTS
From 28 September 2016 to 12 March 2018, 1,103,683 suspected cholera cases (attack rate 3.69%) and 2,385 deaths (case fatality risk 0.22%) were reported countrywide. The epidemic comprised of two distinct waves with a surge in transmission in May 2017, corresponding to a median Rt > 2 in 13 of 23 Governorates. Microbiological analyses suggested that the same V. cholerae O1 Ogawa strain circulated in both waves. We found a positive, non-linear, association between the weekly rainfall and cholera incidence in the following 10 days, with weekly rainfall of 25 mm being associated with a 1.42-fold (95% CI: [1.31 – 1.55]) increase in cholera risk compared to a week without rain.
CONCLUSION
Our analysis suggests that the small first cholera epidemic wave seeded cholera across Yemen during the dry season. When the rains returned in April 2017, they triggered widespread cholera transmission that led to the large second wave.
BACKGROUND
In war-torn Yemen, reports of confirmed cholera started in late September 2016. Cholera continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aim to describe key epidemiological features of this epidemic, including the drivers that triggered the massive surge of cholera cases in May 2017.
METHODS
The Health Authorities of Yemen set up a national cholera surveillance system to collect information on suspected cholera cases presenting at health-facilities and MSF cholera treatment centres. We first conducted descriptive analyses at national and governorate levels. We reconstructed the changes in cholera transmission over time by estimating the instantaneous reproduction number, Rt. Finally, we estimated the association between rainfall and the daily cholera incidence during the increasing phase of the second epidemic wave, from April 15 to June 24 2017, by fitting a spatiotemporal regression model.
RESULTS
From 28 September 2016 to 12 March 2018, 1,103,683 suspected cholera cases (attack rate 3.69%) and 2,385 deaths (case fatality risk 0.22%) were reported countrywide. The epidemic comprised of two distinct waves with a surge in transmission in May 2017, corresponding to a median Rt > 2 in 13 of 23 Governorates. Microbiological analyses suggested that the same V. cholerae O1 Ogawa strain circulated in both waves. We found a positive, non-linear, association between the weekly rainfall and cholera incidence in the following 10 days, with weekly rainfall of 25 mm being associated with a 1.42-fold (95% CI: [1.31 – 1.55]) increase in cholera risk compared to a week without rain.
CONCLUSION
Our analysis suggests that the small first cholera epidemic wave seeded cholera across Yemen during the dry season. When the rains returned in April 2017, they triggered widespread cholera transmission that led to the large second wave.
Journal Article > CommentaryFull Text
Surgery. 2015 July 1; Volume 158 (Issue 1); 33-36.; DOI:10.1016/j.surg.2015.04.006
Elder G, Murphy RA, Herard P, Dilworth K, Olson D, et al.
Surgery. 2015 July 1; Volume 158 (Issue 1); 33-36.; DOI:10.1016/j.surg.2015.04.006