Table 3 Examples of impact at various levels

Global impact

Nifurtimox-eflornithine combination, human African trypanosomiasis, République du Congo (Clinical equivalence study comparing the nifurtimox-eflornithine combination with the standard eflornithine regimen for the treatment of Trypanosoma brucei gambiense) (2003)

Combination treatment now standard in MSF; stimulated DNDi to do the NECT study published in 2009. (Priotto G et al. Nifurtimox-efl ornithine combination therapy for second-stage African Trypanosoma brucei gambiense trypanosomiasis: a multicentre, randomized, phase III, non-inferiority trial. Lancet 2009; 374:56-64.) This led to change in WHO guidelines.

Priotto G et al. Nifurtimox-Eflornithine Combination Therapy for Second-Stage Trypanosoma brucei gambiense Sleeping Sickness: A Randomized Clinical Trial in Congo. Clinical Infectious Diseases 2007; 45:1435–42.

Mental health treatment outcomes in a humanitarian emergency. The evaluation of a pilot model for the integration of mental health into primary care in Habilla, Darfur (2009)

Tremendous success in sharing mental health tools among humanitarian actors

Souza R, Yasuda S, Cristofani S. Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur. Int J Ment Health Syst. 2009;3(1):17.

Tele-medicine/Tele-consultation - Does this service improve health care delivery in a remote conflict setting in Somalia? (2011)

The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and showed that this technology can be vital for training and capacity building. It has led to the expansion and use of telemedicine in similar settings. The study has also featured as a case example in the WHO World Health Report 2013.

Zachariah R et al. Practicing medicine without borders: tele-consultations and tele-mentoring for improving paediatric care in a conflict setting in Somalia? Tropical Medicine and International Health 2012; 17(9) 1156–1162.

Impact within MSF programmes

Outcomes of a diabetic care program in Cambodia: an observational cohort study (2008)

Showed good blood sugar control could be achieved in a low-resource setting. Model of attaching chronic disease to HIV program unique. May be a useful model for other MSF programs looking at chronic diseases.

Raguenaud ME et al. Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study. BMC Med. 2009;7:33. doi:10.1186/1741-7015-7-33.

Compliance and diagnostic profile of referrals from Community Malaria Volunteers to the MSF supported health structures in Bo and Pujehun districts, Sierra Leone (2009)

Highlighted low levels of community based referral completions and its implications at community level. Feeds into future operational strategies related to use of community workers in malaria care

Thomson A et al. Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone. Malaria Journal 2011;10:94.

Surgical site Infection after caesarean section: A proxy for problems in surgical care

Provided information on ways forward to improve post-operative case and improve vigilance on post-operative infection

Chu K et al. Caesarean section rates and indications in sub-Saharan Africa: a multi-country study from Médecins sans Frontières. PLoS One. 2012;7(9):e44484.

Impact at country level

Drug efficacy trial of three artemisinin-based combination therapies: Artesunate + Sulfadoxine-Pyrimethamine, Artesunate + Amodiaquine and Artemether + Lumefantrine (Coartem) for the treatment of uncomplicated Plasmodium falciparum malaria, Republic of Congo (2004)

Led to artemisinin combination therapies becoming the national malaria treatment policy

van den Broek I., Kitz C., Al Attas S., Libama F., Balasegaram M., Guthmann J-P. Efficacy of 3 artemisinin combination therapies for the treatment of uncomplicated Plasmodium falciparum malaria in the Republic of Congo. Malar J 2006 Nov 24;5:113.

Assessing home based treatment and care of MDR-TB patients in northern Uganda (2011)

Findings used for advocacy report to push for implementation of ambulatory treatment in Uganda. Ambulatory model now part of national protocol.

Poster: Casas EC et al. A decentralized community-based MDR-TB model of care in northern Uganda. MSF-UK Scientific Day, 25 May 2012, London, U.K and 43rd Union World Conference on Lung Health.

Local level impact

Reasons why women default from a prevention of mother to child transmission of HIV (PMTCT) program and views of men on PMTCT activities in the informal settlement of Kibera, Nairobi, Kenya (2007)

Helped to generate knowledge on factors associated with default and re-orient the existing programs to improve community acceptability

Kizito KW et al. Lost to follow up from tuberculosis treatment in an urban informal settlement (Kibera), Nairobi, Kenya: what are the rates and determinants? Trans R Soc Trop Med Hyg 2011; 105: 52-57.

A case study of a collaborative initiative between an HIV/AIDS Clinic and a Community Non-Governmental Organization Network in Mumbai, India (2010)

The Mumbai team learned an important lesson regarding followup of defaulters: not to approach the homes, but to contact by other means. To avoid stigma.

Errol L et al. Tracing patients on antiretroviral treatment lost-to-follow-up in an urban slum in India. J Adv Nurs 2012; 68(11); 2399-409.