Publications by authors named "Louisa Baxter"

8 Publications

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A graphic elicitation technique to represent patient rights.

Confl Health 2020 Dec 14;14(1):86. Epub 2020 Dec 14.

Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK.

Background: A patient charter is an explicit declaration of the rights of patients within a particular health care setting. In early 2020 the Save the Children Emergency Health Unit deployed to Cox's Bazar Bangladesh to support the establishment of a severe acute respiratory infection isolation and treatment centre as part of the COVID-19 response. We developed a charter of patient rights and had it translated into Bangla and Burmese; however, the charter remained inaccessible to Rohingya and members of the host community with low literacy.

Methods: To both visualise and contextualise the patient charter we undertook a graphic elicitation method involving both the Rohingya and host communities. We carried out two focus group discussions during which we discussed the charter and agreed how best to illustrate the individual rights contained therein.

Results: Logistical constraints and infection prevention and control procedures limited our ability to follow up with the original focus group participants and to engage in back-translation as we had planned; however, we were able to elicit rich descriptions of each right. Reflecting on our method we were able to identify several key learnings relating to: 1) our technique for eliciting feedback on the charter verbatim versus a broader discussion of concepts referenced within each right, 2) our decision to include both men and women in the same focus group, 3) our decision to ask focus group participants to describe specific features of each illustration and how this benefited the inclusivity of our illustrations, and 4) the potential of the focus groups to act as a means to introduce the charter to communities.

Conclusions: Though executing our method was operationally challenging we were able to create culturally appropriate illustrations to accompany our patient charter. In contexts of limited literacy it is possible to enable access to critical clinical governance and accountability tools.
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http://dx.doi.org/10.1186/s13031-020-00331-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734610PMC
December 2020

Preparing humanitarians to address ethical problems.

Confl Health 2020 Nov 4;14(1):72. Epub 2020 Nov 4.

Chief Executive Officer, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK.

Infectious disease outbreaks represent potentially catastrophic threats to those affected by humanitarian crises. High transmissibility, crowded living conditions, widespread co-morbidities, and a lack of intensive care capacity may amplify the effects of the outbreak on already vulnerable populations and present humanitarian actors with intense ethical problems. We argue that there are significant and troubling gaps in ethical awareness at the level of humanitarian praxis. Though some ethical guidance does exist most of it is directed at public health experts and fails to speak to the day-to-day ethical challenges confronted by frontline humanitarians. In responding to infectious disease outbreaks humanitarian workers are likely to grapple with complex dilemmas opening the door to moral distress and burnout.
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http://dx.doi.org/10.1186/s13031-020-00319-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610160PMC
November 2020

Considerations for planning COVID-19 treatment services in humanitarian responses.

Confl Health 2020 Nov 25;14(1):80. Epub 2020 Nov 25.

Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.

The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
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http://dx.doi.org/10.1186/s13031-020-00325-6DOI Listing
November 2020

Considerations for planning COVID-19 treatment services in humanitarian responses.

Confl Health 2020 25;14:80. Epub 2020 Nov 25.

Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK.

The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
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http://dx.doi.org/10.1186/s13031-020-00325-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686825PMC
November 2020

Mobile clinics in humanitarian emergencies: a systematic review.

Confl Health 2020 30;14. Epub 2020 Jan 30.

3Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.

Background: Despite the widespread reliance on mobile clinics for delivering health services in humanitarian emergencies there is little empirical evidence to support their use. We report a narrative systematic review of the empirical evidence evaluating the use of mobile clinics in humanitarian settings.

Methods: We searched MEDLINE, EMBASE, Global Health, Health Management Information Consortium, and The Cochrane Library for manuscripts published between 2000 and 2019. We also conducted a grey literature search via Global Health, Open Grey, and the WHO publication database. Empirical studies were included if they reported on at least one of the following evaluation criteria: relevance/appropriateness, connectedness, coherence, coverage, efficiency, effectiveness, and impact.

Findings: Five studies met the inclusion criteria: all supported the use of mobile clinics in the particular setting under study. Three studies included controls. Two studies were assessed as good quality. The studies reported on mobile clinics providing non-communicable disease interventions, mental health services, sexual and reproductive health services, and multiple primary health care services in Afghanistan, the Democratic Republic of the Congo , Haiti, and the Occupied Palestinian Territories. Studies assessed one or more of the following evaluation domains: relevance/appropriateness, coverage, efficiency, and effectiveness. Four studies made recommendations including: i) ensure that mobile clinics are designed to complement clinic-based services; ii) improve technological tools to support patient follow-up, improve record-keeping, communication, and coordination; iii) avoid labelling services in a way that might stigmatise attendees; iv) strengthen referral to psychosocial and mental health services; v) partner with local providers to leverage resources; and vi) ensure strong coordination to optimise the continuum of care. Recommendations regarding the of mobile clinics include carrying out comparative studies of various modalities (including fixed facilities and community health workers) in order to isolate the effects of the mobile clinics. In the absence of a sound evidence base informing the use of mobile clinics in humanitarian crises, we encourage the integration of: i) WASH services, ii) nutrition services, iii) epidemic surveillance, and iv) systems to ensure the quality and safety of patient care. We recommend that future evaluations report against an established evaluation framework.

Conclusion: Evidence supporting the use of mobile clinics in humanitarian emergencies is limited. We encourage more studies of the use of mobile clinics in emergency settings.

Funding: Salary support for this review was provided under the RECAP project by United Kingdom Research and Innovation as part of the Global Challenges Research Fund, grant number ES/P010873/1.
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http://dx.doi.org/10.1186/s13031-020-0251-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993397PMC
January 2020

Access to care for non-communicable diseases in Mosul, Iraq between 2014 and 2017: a rapid qualitative study.

Confl Health 2018 29;12:48. Epub 2018 Dec 29.

1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

During June 2014 to April 2017, the population of Mosul, Iraq lived in a state of increasing isolation from the rest of Iraq due to the city's occupation by the Islamic State group. As part of a study to develop a generalisable method for estimating the excess burden of non-communicable diseases (NCDs) in conflict-affected settings, in April-May 2017 we conducted a brief qualitative study of self-reported care for NCDs among 15 adult patients who had fled Mosul and presented to Médecins Sans Frontières clinics in the Kurdistan region with hypertension and/or diabetes. Participants reported consistent barriers to NCD care during the so-called Islamic State period, including drug shortages, insecurity and inability to afford privately sold medication. Coping strategies included drug rationing. By 2016, all patients had completely or partially lost access to care. Though limited, this study suggests a profound effect of the conflict on NCD burden.
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http://dx.doi.org/10.1186/s13031-018-0183-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311030PMC
December 2018

Impact of war on child health in northern Syria: the experience of Médecins Sans Frontières.

Eur J Pediatr 2018 Mar 19;177(3):371-380. Epub 2017 Dec 19.

Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands.

Few data are available to evaluate the impact of Syrian war on civilian population; to describe this impact on child health, this article uses data from Médecins Sans Frontières-Operational Centre Amsterdam's activities in Tal-Abyad and Kobane cities, northern Syria (2013-2016). Data were obtained from routine medical datasets and narrative reports, for out-patient clinics, immunisation, nutritional monitoring and assessments, and in-patient care, and were analysed quantitatively and qualitatively. Infections were the largest contributor to morbidity. The proportion of < 5 year out-patient consultations of infectious diseases that are listed for outbreak monitoring in emergencies was 15% in 2013, 51% in 2014, 75% in 2015 and 70% in 2016. Thalassemia was recorded in 0.5% of 2014 < 5 year out-patient consultations and 3.4% of 2013-2014 < 18-year in-patient admissions. Measles immunisation activities and routine Extended Programme for Immunisation were re-activated across northern Syria; however, immunisation coverage could not be calculated. Results from our routine data must be compared cautiously, due to differences in settings and disease categories.

Conclusion: With such scattered interventions, routine data are limited in providing a quantified evidence of emergency's health impact; however, they help in drawing a picture of children's health status and highlighting difficulties in providing curative and preventive services, in order to reflect part of population's plight. What is Known • Few data exist to evaluate the impact of the Syrian war on the health of children; • Médecins Sans Frontières (MSF-OCA) has worked in northern Syria during different times since 2013. What is New • Quantitative and qualitative analysis of MSF's routine medical data and situtation reports show that one fifth of all consultations in children < 5 years in MSF health facilities in northern Syria 2013-2016 were due to communicable diseases; • The analysis also highlights the burden of chronic conditions that were prevalent in Syria before the war, e.g. thalassemia.
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http://dx.doi.org/10.1007/s00431-017-3057-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816770PMC
March 2018

Implementing the patient-centered medical home model for chronic disease care in small medical practices: practice group characteristics and physician understanding.

Am J Med Qual 2013 Mar-Apr;28(2):113-9. Epub 2012 Aug 28.

London Deanery, London, United Kingdom.

Strengthening primary care may improve health outcomes and restrain spending. The patient-centered medical home (PCMH) model is endorsed as a tool to achieve this. Early evaluations in large group practices demonstrate improvements in some health outcomes. Evidence is lacking from small medical practices that deliver the majority of primary health care. This was a national survey of 200 physicians that explored perceptions of PCMH. There was considerable interest in adoption of the model; however, providing PCMH care was seen as an extension of traditional roles that requires additional reimbursement. No differentiation was made among a variety of payment models to do this. All joint principle components of the model were identified as important: extending access and information technology were the most contentious. There was consensus that PCMH might improve the quality of primary care; however, tension between wider societal benefits and rising costs for individual practices was a challenge to implementation.
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http://dx.doi.org/10.1177/1062860612454451DOI Listing
February 2014