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Mizrachi M, Levy E, Dror AA, Sela E, Kutikov S, Barhoum M, Ronen O, Gruber M. Humanitarian Outpatient Pediatric Endeavor (HOPE): A Novel Specialist Ambulatory Health-Care Concept in Conflict Areas. Disaster Med Public Health Prep 2023; 17:e498. [PMID: 37781787 DOI: 10.1017/dmp.2023.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
With the collapse of the medical system in Syria, Israel began providing Syrians with humanitarian aid, first to the war-injured and then general medical treatment. We developed a novel specialist ambulatory care concept to provide medical care for Syrian children. Children with their caregivers were transported by bus across the border from Syria to our medical center in Israel for day-stay outpatient-clinic advanced evaluation and treatment due to coordination between Syrian, Red Cross, and Israeli authorities, including Israeli Defense Forces. This retrospective field report includes 371 Syrian children treated as outpatients at Galilee Medical Center between January 2016 and September 2018. In our experience, this novel pediatric ambulatory care concept has been feasible, efficient, and successful in providing specialist care for children in a crisis region devoid of access to health care. We believe it can also serve adult patients and be implemented in other crises and disasters scenarios.
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Affiliation(s)
- Matti Mizrachi
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Einat Levy
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amiel A Dror
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eyal Sela
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Administration, Galilee Medical Center, Nahariya, Israel
| | - Ohad Ronen
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maayan Gruber
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Singh S, Scott W, Yeager C, Rambaran M, Singh NC, Nelin LD. Implementation of a Level III neonatal intensive care unit was associated with reduced NICU mortality in a resource limited public tertiary care hospital in Guyana, South America. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000651. [PMID: 36962726 PMCID: PMC10021212 DOI: 10.1371/journal.pgph.0000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
Neonatal mortality is a significant contributor to child mortality, and there is increasing interest in low resource settings to implement neonatal intensive care practices to lower neonatal mortality. In Guyana, South America neonatal mortality remains relatively high. At Georgetown Public Hospital Corporation (GPHC), the only tertiary referral hospital in Guyana, a Level III NICU was developed starting in January, 2012 with full implementation in September, 2015. In this study, we report the association of the implementation of a Level III NICU with in-hospital neonatal survival at GPHC. Using an observational study design, available data were collected from January 1, 2015 through September 30, 2020. During the study period, there were 30,733 deliveries at GPHC and 4,467 admissions to the NICU at GPHC. There were no significant changes in the numbers of births or NICU admissions during the time of the study. The survival rate for patients admitted to the NICU was ~64% during the first 3 quarters of 2015 with most deaths were caused by sepsis or respiratory failure. By the last quarter of 2015, the NICU survival rate increased dramatically and has been sustained at ~87% (p<0.0001). The inborn mortality rate at GPHC, calculated as a percentage of all live births at GPHC, was 2.9% prior to the full implementation of the NICU and was 1.4% after the full implementation of the NICU (p<0.0001). These findings suggest that the implementation of a Level III NICU at GPHC was associated with an improvement in survival to NICU discharge in a resource limited setting.
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Affiliation(s)
- Sara Singh
- Paediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana
- Institute for Health Sciences Education, Georgetown, Guyana
| | - Winsome Scott
- Paediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana
- Institute for Health Sciences Education, Georgetown, Guyana
| | - Caitlin Yeager
- Guyana Help the Kids, Toronto, ON, Canada
- Breen School of Nursing and Health Professions, Ursuline College, Pepper Pike, OH, United States of America
| | - Madan Rambaran
- Paediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana
- Institute for Health Sciences Education, Georgetown, Guyana
| | | | - Leif D Nelin
- Guyana Help the Kids, Toronto, ON, Canada
- Division of Neonatology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, United States of America
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Rodo M, Duclos D, DeJong J, Akik C, Singh NS. A systematic review of newborn health interventions in humanitarian settings. BMJ Glob Health 2022; 7:e009082. [PMID: 35777926 PMCID: PMC9252185 DOI: 10.1136/bmjgh-2022-009082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Almost half of the under-5 deaths occur in the neonatal period and most can be prevented with quality newborn care. The already vulnerable state of newborns is exacerbated in humanitarian settings. This review aims to assess the current evidence of the interventions being provided in these contexts, identify strategies that increase their utilisation and their effects on health outcomes in order to inform involved actors in the field and to guide future research. METHODS Searched for peer-reviewed and grey literature in four databases and in relevant websites, for published studies between 1990 and 15 November 2021. Search terms were related to newborns, humanitarian settings, low-income and middle-income countries and newborn health interventions. Quality assessment using critical appraisal tools appropriate to the study design was conducted. Data were extracted and analysed using a narrative synthesis approach. RESULTS A total of 35 articles were included in this review, 33 peer-reviewed and 2 grey literature publications. The essential newborn care (ENC) interventions reported varied across the studies and only three used the Newborn Health in Humanitarian Settings: Field Guide as a guideline document. The ENC interventions most commonly reported were thermal care and feeding support whereas delaying of cord clamping and administration of vitamin K were the least. Training of healthcare workers was the most frequent strategy reported to increase utilisation. Community interventions, financial incentives and the provision of supplies and equipment were also reported. CONCLUSION There is insufficient evidence documenting the reality of newborn care in humanitarian settings in low-income and middle-income countries. There is a need to improve the reporting of these interventions, including when there are gaps in service provision. More evidence is needed on the strategies used to increase their utilisation and the effect on health outcomes. PROSPERO REGISTRATION NUMBER CRD42020199639.
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Affiliation(s)
- Mariana Rodo
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Diane Duclos
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jocelyn DeJong
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Neha S Singh
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
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Russell N, Tappis H, Mwanga JP, Black B, Thapa K, Handzel E, Scudder E, Amsalu R, Reddi J, Palestra F, Moran AC. Implementation of maternal and perinatal death surveillance and response (MPDSR) in humanitarian settings: insights and experiences of humanitarian health practitioners and global technical expert meeting attendees. Confl Health 2022; 16:23. [PMID: 35526012 PMCID: PMC9077967 DOI: 10.1186/s13031-022-00440-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/03/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Maternal and perinatal death surveillance and response (MPDSR) is a system of identifying, analysing and learning lessons from such deaths in order to respond and prevent future deaths, and has been recommended by WHO and implemented in many low-and-middle income settings in recent years. However, there is limited documentation of experience with MPDSR in humanitarian settings. A meeting on MPDSR in humanitarian settings was convened by WHO, UNICEF, CDC and Save the Children, UNFPA and UNHCR on 17th-18th October 2019, informed by semi-structured interviews with a range of professionals, including expert attendees. CONSULTATION FINDINGS Interviewees revealed significant obstacles to full implementation of the MPDSR process in humanitarian settings. Many obstacles were familiar to low resource settings in general but were amplified in the context of a humanitarian crisis, such as overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicisation of mortality. Factors more unique to humanitarian contexts included concerns about health worker security and moral distress. There are varying levels of institutionalisation and implementation capacity for MPDSR within humanitarian organisations. It is suggested that if poorly implemented, particularly with a punitive or blame approach, MPDSR may be counterproductive. Nevertheless, successes in MPDSR were described whereby the process led to concrete actions to prevent deaths, and where death reviews have led to improved understanding of complex and rectifiable contextual factors leading to deaths in humanitarian settings. CONCLUSIONS Despite the challenges, examples exist where the lessons learnt from MPDSR processes have led to improved access and quality of care in humanitarian contexts, including successful advocacy. An adapted approach is required to ensure feasibility, with varying implementation being possible in different phases of crises. There is a need for guidance on MPDSR in humanitarian contexts, and for greater documentation and learning from experiences.
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Affiliation(s)
| | - Hannah Tappis
- grid.21107.350000 0001 2171 9311Jhpiego, Baltimore, MD USA
| | - Jean Paul Mwanga
- Hôpital Générale de Mweso, Nord Kivu, Democratic Republic of the Congo
| | - Benjamin Black
- grid.452780.cMédecins Sans Frontières, Amsterdam, The Netherlands
| | - Kusum Thapa
- grid.21107.350000 0001 2171 9311Jhpiego, Baltimore, MD USA
| | - Endang Handzel
- grid.416738.f0000 0001 2163 0069Centre for Disease Control and Prevention, Atlanta, GA USA
| | - Elaine Scudder
- grid.420433.20000 0000 8728 7745International Rescue Committee, New York, NY USA
| | - Ribka Amsalu
- grid.266102.10000 0001 2297 6811University of California San Francisco, San Francisco, CA USA
| | - Jyoti Reddi
- grid.3575.40000000121633745World Health Organization, Geneva, Switzerland
| | - Francesca Palestra
- grid.3575.40000000121633745World Health Organization, Geneva, Switzerland
| | - Allisyn C. Moran
- grid.3575.40000000121633745World Health Organization, Geneva, Switzerland
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Kabugo D, Nakamura H, Magnusson B, Vaughan M, Niyonshaba B, Nakiganda C, Otai C, Haddix-McKay K, Seela M, Nankabala J, Nakakande J, Ssekidde M, Tann CJ, Al-Haddad BJS, Nyonyintono J, Mubiri P, Waiswa P, Paudel M. Mixed-method study to assess the feasibility, acceptability and early effectiveness of the Hospital to Home programme for follow-up of high-risk newborns in a rural district of Central Uganda: a study protocol. BMJ Open 2021; 11:e043773. [PMID: 33653756 PMCID: PMC7929893 DOI: 10.1136/bmjopen-2020-043773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/07/2021] [Accepted: 02/10/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION A follow-up programme designed for high-risk newborns discharged from inpatient newborn units in low-resource settings is imperative to ensure these newborns receive the healthiest possible start to life. We aim to assess the feasibility, acceptability and early outcomes of a discharge and follow-up programme, called Hospital to Home (H2H), in a neonatal unit in central Uganda. METHODS AND ANALYSIS We will use a mixed-methods study design comparing a historical cohort and an intervention cohort of newborns and their caregivers admitted to a neonatal unit in Uganda. The study design includes two main components. The first component includes qualitative interviews (n=60 or until reaching saturation) with caregivers, community health workers called Village Health Team (VHT) members and neonatal unit staff. The second component assesses and compares outcomes between a prospective intervention cohort (n=100, born between July 2019 and September 2019) and a historical cohort (n=100, born between July 2018 and September 2018) of infants. The historical cohort will receive standard care while the intervention cohort will receive standard care plus the H2H intervention. The H2H intervention comprises training for healthcare workers on lactation, breast feeding and neurodevelopmentally supportive care, including cue-based feeding, and training to caregivers on recognition of danger signs and care of their high-risk infants. Infants and their families receive home visits until 6 months of age, or longer if necessary, by specially trained VHTs. Quantitative data will be analysed using descriptive statistics and regression analysis. All results will be stratified by cohort group. Qualitative data will be analysed guided by Braun and Clarke's thematic analysis technique. ETHICS AND DISSEMINATION This study protocol was approved by the relevant Ugandan ethics committees. All participants will provide written informed consent. We will disseminate through peer-reviewed publications and key stakeholders and public engagement. TRIAL REGISTRATION NUMBER ISRCTN51636372; Pre-result.
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Affiliation(s)
- Daniel Kabugo
- Adara Development (Uganda), Adara Group, Nakaseke, Uganda
| | - Heidi Nakamura
- Adara Development (USA), Adara Group, Edmonds, Washington, USA
| | | | - Madeline Vaughan
- Adara Development (Australia), Adara Group, Sydney, New South Wales, Australia
| | | | | | - Christine Otai
- Adara Development (Uganda), Adara Group, Nakaseke, Uganda
| | - Kimber Haddix-McKay
- Adara Development (USA), Adara Group, Edmonds, Washington, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | | | | | | | | | - Cally J Tann
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Neonatal Medicine, University College London Hospitals NHS Trust, London, UK
| | - Benjamin J S Al-Haddad
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | | | - Paul Mubiri
- School of Public Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Makerere University Centre of Excellence for Maternal Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
| | - Mohan Paudel
- Adara Development (Australia), Adara Group, Sydney, New South Wales, Australia
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Lundeby KM, Heen E, Mosa M, Abdi A, Størdal K. Neonatal morbidity and mortality in Hargeisa, Somaliland: an observational, hospital based study. Pan Afr Med J 2020; 37:3. [PMID: 32983321 PMCID: PMC7501748 DOI: 10.11604/pamj.2020.37.3.24741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction Hargeisa Group Hospital, Somaliland, opened a neonatal unit in 2013. We aimed to study causes of admission, risk factors for neonatal death and post-discharge care to address modifiable factors. Methods we analysed hospital records from June-October 2013 (n=164). In addition, we reached primary caregivers of 94 patients for further information after discharge. Results of the 164 patients, 65% were male, 31% weighed <2500 grams, 16% were premature, 43% were exposed to meconium and 29% had premature rupture of membranes (PROM). Twenty-seven percent were admitted after caesarean section and 36% had been bag-mask ventilated. The most common diagnoses for admission were asphyxia (34%), respiratory distress (27%), sepsis (16%) and prematurity (15%). The mortality before discharge was 15%, 23/1430 (1.6%) of live-born at the hospital. Half of the admitted preterm babies died (RR for death for preterm vs term born 4.6, 95% CI 2.3-9.0) as well as 28% of the patients with birth weight <2500 grams (RR 2.1, 95% CI 1.0-4.2). The mortality rate with or without PROM was 29% vs 15% (RR 2.0, 95% CI 1.0-3.9). At 28 days of age, 34% of the patients were exclusively breastfed and 44% had not yet been vaccinated. Diarrhoea, vomiting and/or respiratory distress after discharge were reported for 44%. Conclusion prematurity and low birth weight were important risk factors for neonatal death in this cohort, contributing to the high mortality rate. Low numbers of exclusively breastfed and vaccinated infants are also issues of concern to be targeted in the peri- and postnatal care.
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Affiliation(s)
- Karen Marie Lundeby
- Hargeisa Group Hospital, Hargeisa, Somaliland.,Oslo University Hospital, Oslo, Norway
| | - Espen Heen
- Hargeisa Group Hospital, Hargeisa, Somaliland.,University of Oslo, Oslo, Norway
| | | | - Abdirashid Abdi
- Hargeisa Group Hospital, Hargeisa, Somaliland.,Ohio State University Wexner Medical Center, Columbus, USA
| | - Ketil Størdal
- Oslo University Hospital, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway.,Ostfold Hospital Trust, Sarpsborg, Norway
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Pekelharing JE, Gatluak F, Harrison T, Maldonado F, Siddiqui MR, Ritmeijer K. Outcomes of visceral leishmaniasis in pregnancy: A retrospective cohort study from South Sudan. PLoS Negl Trop Dis 2020; 14:e0007992. [PMID: 31978116 PMCID: PMC7001985 DOI: 10.1371/journal.pntd.0007992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/05/2020] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Visceral leishmaniasis (VL) is endemic in South Sudan, where outbreaks occur frequently. Because of changes in the immune system during pregnancy, pregnant women are considered particularly vulnerable for developing complications of VL disease, including opportunistic infections. There is limited evidence available about clinical aspects and treatment outcomes of VL in pregnancy. We describe characteristics, maternal and pregnancy outcomes from a cohort of pregnant women with VL. Methods We conducted a retrospective analysis using routine programme data from a MSF health facility in Lankien, Jonglei State, South Sudan, between Oct 2014 and April 2018. Records were extracted of women diagnosed with VL while pregnant, and those symptomatic during pregnancy but diagnosed during the first two weeks postpartum. Records were matched with a random sample of non-pregnant women of reproductive age (15–45 years) with VL from the same period. Results We included 113 women with VL in pregnancy, and 223 non-pregnant women with VL. Women with VL in pregnancy presented with more severe anaemia, were more likely to need blood transfusion (OR 9.3; 95%CI 2.5–34.2) and were more often prescribed antibiotics (OR 6.0; 95%CI 3.4–10.6), as compared to non-pregnant women with VL. Adverse pregnancy outcomes, including miscarriage and premature delivery, were reported in 20% (16/81) where VL was diagnosed in pregnancy, and 50% 13/26) where VL was diagnosed postpartum. Postpartum haemorrhage was common. Pregnant women were more likely to require extension of treatment to achieve cure (OR 10.0; 95%CI 4.8–20.9), as compared to non-pregnant women with VL. Nevertheless, overall initial cure rates were high (96.5%) and mortality was low (1.8%) in this cohort of pregnant women with VL. Conclusion This is the largest cohort in the literature of VL in pregnancy. Our data suggest that good maternal survival rates are possible in resource-limited settings, despite the high incidence of complications. Visceral leishmaniases (VL), also known as ‘Kala azar’, is a parasitic disease transmitted by sand flies. South Sudan is one of the countries in the world with the highest disease burden of VL. Existing evidence about treatment and outcomes of VL in pregnancy is limited. We described outcomes of pregnant women with VL and women diagnosed with VL in the first two weeks postpartum. Pregnant women with VL were treated with liposomal amphotericin B (AmBisome) in this cohort. Survival rates and initial cure rates of women with VL in pregnancy treated in this resource constrained setting were high. However, these patients often required extension of treatment to achieve cure after the initial standard dose of 30mg/kg AmBisome in six doses. Careful evaluation of patients is needed at the end of the standard treatment regimen, in order to ensure proper (parasitological) cure before discharge. We reported a high incidence of complications (including severe anaemia with a need for blood transfusion), adverse pregnancy outcomes (including miscarriage and premature delivery), and obstetric complications. This research adds to the existing body of knowledge concerning VL in pregnancy, although several questions about this condition remain unanswered. Topics for future research include the immunological response to leishmania infection in pregnancy, and maternal, pregnancy and neonatal outcomes after discharge from VL treatment.
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Affiliation(s)
| | | | - Tim Harrison
- Médecins Sans Frontières, Amsterdam, Netherlands
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Umphrey L, Brown A, Hiffler L, Lafferty N, Garcia DM, Morton N, Ogundipe O. Delivering paediatric critical care in humanitarian settings. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:846-848. [PMID: 30297309 DOI: 10.1016/s2352-4642(18)30284-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Lisa Umphrey
- Médecins Sans Frontières, Operational Centre Paris, Glebe, NSW 2037, Australia.
| | - Alexandra Brown
- Médecins Sans Frontières, Operational Centre Paris, Glebe, NSW 2037, Australia
| | - Laurent Hiffler
- Médecins Sans Frontières, Operational Centre Barcelona, Barcelona, Spain
| | - Nadia Lafferty
- Médecins Sans Frontières, Operational Centre Barcelona, Barcelona, Spain
| | | | - Nikola Morton
- Médecins Sans Frontières, Operational Centre Paris, Glebe, NSW 2037, Australia
| | - Oluwakemi Ogundipe
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
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