Conference Material > Abstract
Chandna A, PRIORITISE Study Group, Mahajan R, Gautam P, Mwandigha L, et al.
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/hxy9-yk07
INTRODUCTION
In locations where few people have received Covid-19 vaccines, health systems remain vulnerable to spikes in SARS-CoV-2 infections. Triage tools, which could include biomarkers, to identify patients with moderate Covid-19 infection suitable for community-based management would be useful in the event of surges. In consultation with FIND (Geneva, Switzerland) we shortlisted seven biomarkers for evaluation, all measurable using point-of-care tests, and either currently available or in late-stage development.
METHODS
We prospectively recruited unvaccinated adults with laboratory-confirmed Covid-19 presenting to two hospitals in India with moderate symptoms, in order to develop and validate a clinical prediction model to rule-out progression to supplemental oxygen requirement. Moderate disease was defined as oxygen saturation (SpO2) ≥ 94% and respiratory rate < 30 breaths per minute (bpm), in the context of systemic symptoms (breathlessness or fever and chest pain, abdominal pain, diarrhoea, or severe myalgia). All patients had clinical observations and blood collected at presentation, and were followed up for 14 days for the primary outcome, defined as any of the following: SpO2 < 94%; respiratory rate > 30 bpm; SpO2/fraction of inspired oxygen (FiO2) < 400; or death. We specified a priori that each model would contain three easily ascertained clinical parameters (age, sex, and SpO2) and one of the seven biomarkers (C-reactive protein (CRP), D-dimer, interleukin-6 (IL-6), neutrophil-to-lymphocyte ratio (NLR), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), or soluble urokinase plasminogen activator receptor (suPAR)), to ensure the models would be implementable in high patient-throughput, low-resource settings. We evaluated the models’ discrimination, calibration, and clinical utility in a held-out external temporal validation cohort.
ETHICS
Ethical approval was given by the ethics committees of AIIMS and CMC, India, the Oxford Tropical Research Ethics Committee, UK; and by the MSF Ethics Review Board.
ClinicalTrials.gov number, NCT04441372.
RESULTS
426 participants were recruited, of which 89 (21.0%) met the primary outcome. 257 participants comprised the development, and 166 the validation, cohorts. The three models containing NLR, suPAR, or IL-6 demonstrated promising discrimination (c-statistics: 0.72 to 0.74) and calibration (calibration slopes: 1.01 to 1.05) in the held-out validation cohort. Furthermore, they provided greater utility than a model containing the clinical parameters alone (c-statistic = 0.66; calibration slope = 0.68). The inclusion of either NLR or suPAR improved predictive performance such that the ratio of correctly to incorrectly discharged patients increased from 10:1 to 23:1 or 25:1 respectively. Including IL-6 resulted in a similar proportion (~21%) of correctly discharged patients as the clinical model, but without missing any patients requiring supplemental oxygen.
CONCLUSION
We present three clinical prediction models that could help clinicians identify patients with moderate Covid-19 suitable for community-based management. These models are readily implementable and, if validated, could be of particular relevance for resource-limited settings.
CONFLICTS OF INTEREST
None declared.
In locations where few people have received Covid-19 vaccines, health systems remain vulnerable to spikes in SARS-CoV-2 infections. Triage tools, which could include biomarkers, to identify patients with moderate Covid-19 infection suitable for community-based management would be useful in the event of surges. In consultation with FIND (Geneva, Switzerland) we shortlisted seven biomarkers for evaluation, all measurable using point-of-care tests, and either currently available or in late-stage development.
METHODS
We prospectively recruited unvaccinated adults with laboratory-confirmed Covid-19 presenting to two hospitals in India with moderate symptoms, in order to develop and validate a clinical prediction model to rule-out progression to supplemental oxygen requirement. Moderate disease was defined as oxygen saturation (SpO2) ≥ 94% and respiratory rate < 30 breaths per minute (bpm), in the context of systemic symptoms (breathlessness or fever and chest pain, abdominal pain, diarrhoea, or severe myalgia). All patients had clinical observations and blood collected at presentation, and were followed up for 14 days for the primary outcome, defined as any of the following: SpO2 < 94%; respiratory rate > 30 bpm; SpO2/fraction of inspired oxygen (FiO2) < 400; or death. We specified a priori that each model would contain three easily ascertained clinical parameters (age, sex, and SpO2) and one of the seven biomarkers (C-reactive protein (CRP), D-dimer, interleukin-6 (IL-6), neutrophil-to-lymphocyte ratio (NLR), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), or soluble urokinase plasminogen activator receptor (suPAR)), to ensure the models would be implementable in high patient-throughput, low-resource settings. We evaluated the models’ discrimination, calibration, and clinical utility in a held-out external temporal validation cohort.
ETHICS
Ethical approval was given by the ethics committees of AIIMS and CMC, India, the Oxford Tropical Research Ethics Committee, UK; and by the MSF Ethics Review Board.
ClinicalTrials.gov number, NCT04441372.
RESULTS
426 participants were recruited, of which 89 (21.0%) met the primary outcome. 257 participants comprised the development, and 166 the validation, cohorts. The three models containing NLR, suPAR, or IL-6 demonstrated promising discrimination (c-statistics: 0.72 to 0.74) and calibration (calibration slopes: 1.01 to 1.05) in the held-out validation cohort. Furthermore, they provided greater utility than a model containing the clinical parameters alone (c-statistic = 0.66; calibration slope = 0.68). The inclusion of either NLR or suPAR improved predictive performance such that the ratio of correctly to incorrectly discharged patients increased from 10:1 to 23:1 or 25:1 respectively. Including IL-6 resulted in a similar proportion (~21%) of correctly discharged patients as the clinical model, but without missing any patients requiring supplemental oxygen.
CONCLUSION
We present three clinical prediction models that could help clinicians identify patients with moderate Covid-19 suitable for community-based management. These models are readily implementable and, if validated, could be of particular relevance for resource-limited settings.
CONFLICTS OF INTEREST
None declared.
Conference Material > Slide Presentation
Schittecatte G, Pellechia U, Meudec M, Vanlerberghe V
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/79m2-8h12
Conference Material > Slide Presentation
Ali Dubad B, Baertlein L, Piening T, Chindong I, Sahelie B, et al.
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/8bp2-4234
Conference Material > Abstract
Hadiuzzaman M, Yantzi R, van den Boogaard W, Lim SY, Gupta PS, et al.
MSF Scientific Days International 2022. 2022 May 12; DOI:10.57740/2hjs-zc19
INTRODUCTION
Maternal health indicators remain unacceptably poor within the densely populated Rohingya refugee camps in Cox’s Bazar, Bangladesh. With a high prevalence of home births, we sought to explore perceptions, experiences, and expectations around delivery care of women of reproductive age. We also examined the potential roles of family and key community members within Camp 22, a relatively isolated camp with 23,000 refugees where MSF is the only provider of facility-based maternity care.
METHODS
In 2021, we selected 45 participants from Camp 22 through purposive and snowball sampling for in-depth interviews. Participants included 36 Rohingya women and their family members, three traditional birth attendants (TBA’s) and six community and religious leaders. Interviews were recorded, translated and transcribed into English by trained staff fluent in Rohingya. Thematic-content analysis was performed, whereby codes and emerging themes were identified.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the ERB of Bangladesh University of Health Sciences.
RESULTS
Findings showed that delivery choices were made as a family, with husband and parents-in-law being primary decision makers. An uncomplicated birth was not perceived as requiring facility-based assistance; many women preferred to give birth at home assisted by TBA’s, family, or local healers, due to placing greater trust in their own community. Lack of security and transport were crucial determinants in repudiating facility-based care at night. Concerns about male staff and being undressed during facility-based births, as well as the possibility of onward referrals should surgery or episiotomies be required, drove hesitancy. Separation from family and children added more anxiety. Lack of understanding by facility staff towards Rohingya birthing practices and beliefs, and the Rohingya’s unfamiliarity with formally-trained midwives and medical procedures, featured heavily in decisions for home births. Factors such as utilising birthing ropes and guaranteed privacy at home were key influencers for choosing home births. Additionally, perceived inexperience of midwives and lack of autonomy while in the facility, were other common reasons for apprehension.
CONCLUSION
This study emphasizes community trust as a factor in collective decision-making regarding birth choices. Trust was higher in TBA’s than in formally-trained midwives and this negatively affected perceptions regarding competence. Perceptions may also be affected by rapid midwife turnover, a factor endemic to non-governmental organizations working in Cox’s Bazar. The persistent gap in cultural understanding and adaptation by facility-based staff, even after three years of presence, suggests the need for a more iterative, inclusive and reflective approach, with community engagement strategies founded on beneficiaries own explicitly stated needs, beliefs and practices.
CONFLICTS OF INTEREST
None declared
Maternal health indicators remain unacceptably poor within the densely populated Rohingya refugee camps in Cox’s Bazar, Bangladesh. With a high prevalence of home births, we sought to explore perceptions, experiences, and expectations around delivery care of women of reproductive age. We also examined the potential roles of family and key community members within Camp 22, a relatively isolated camp with 23,000 refugees where MSF is the only provider of facility-based maternity care.
METHODS
In 2021, we selected 45 participants from Camp 22 through purposive and snowball sampling for in-depth interviews. Participants included 36 Rohingya women and their family members, three traditional birth attendants (TBA’s) and six community and religious leaders. Interviews were recorded, translated and transcribed into English by trained staff fluent in Rohingya. Thematic-content analysis was performed, whereby codes and emerging themes were identified.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the ERB of Bangladesh University of Health Sciences.
RESULTS
Findings showed that delivery choices were made as a family, with husband and parents-in-law being primary decision makers. An uncomplicated birth was not perceived as requiring facility-based assistance; many women preferred to give birth at home assisted by TBA’s, family, or local healers, due to placing greater trust in their own community. Lack of security and transport were crucial determinants in repudiating facility-based care at night. Concerns about male staff and being undressed during facility-based births, as well as the possibility of onward referrals should surgery or episiotomies be required, drove hesitancy. Separation from family and children added more anxiety. Lack of understanding by facility staff towards Rohingya birthing practices and beliefs, and the Rohingya’s unfamiliarity with formally-trained midwives and medical procedures, featured heavily in decisions for home births. Factors such as utilising birthing ropes and guaranteed privacy at home were key influencers for choosing home births. Additionally, perceived inexperience of midwives and lack of autonomy while in the facility, were other common reasons for apprehension.
CONCLUSION
This study emphasizes community trust as a factor in collective decision-making regarding birth choices. Trust was higher in TBA’s than in formally-trained midwives and this negatively affected perceptions regarding competence. Perceptions may also be affected by rapid midwife turnover, a factor endemic to non-governmental organizations working in Cox’s Bazar. The persistent gap in cultural understanding and adaptation by facility-based staff, even after three years of presence, suggests the need for a more iterative, inclusive and reflective approach, with community engagement strategies founded on beneficiaries own explicitly stated needs, beliefs and practices.
CONFLICTS OF INTEREST
None declared
Conference Material > Poster
Obach D, Fares K, Woolley SC, Jean-Louis C, Denis O, et al.
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/t33d-2m41
Conference Material > Poster
Cazes C, Sirna F, Phelan KPQ, Hubert V, Tshiala BK, et al.
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/cbcx-vk63
Conference Material > Slide Presentation
Lavilla KM, Teal J, Schausberger B, Sankoh M, Conteh AB, et al.
MSF Scientific Days International 2022. 2022 May 11; DOI:10.57740/pyhg-f359
Conference Material > Abstract
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/b641-d608
INTRODUCTION
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
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 (talk)
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