RESUMEN
Introduction: Providing hemodialysis to patients with kidney failure (KF) in conflict-affected areas poses a significant challenge. Achieving and sustaining reasonable quality hemodialysis operations in such regions necessitates a comprehensive approach. Methods: In the conflict area of Northwest (NW) Syria, a 3-phase project was initiated to address the quality of hemodialysis operations. The assessment phase involved the examination of infection prevention and control (IPC) protocols, staff training, medical protocols, individualized hemodialysis prescriptions, and laboratory testing capabilities. The second phase involved activities toward capacity building and implementing an action plan based on feasibility and sustainability. Results: The assessment phase revealed that only 7 of 14 centers had IPC protocols, and 8 centers provided IPC training for their staff. Furthermore, only 7 centers had medical protocols, and 5 used individualized hemodialysis prescriptions. Difficulties in testing for potassium was reported in 7 centers and the inability to perform hepatitis B and C serologies was reported in 3 centers. Only 2 centers adhered to machine and water treatment system maintenance guidelines, and 4 conducted daily water quality checks. Recommendations were formulated, and an action plan was developed for implementation in the second phase. The plan encompassed enhancements in IPC practices, medical protocols, record-keeping, laboratory testing, and equipment maintenance. Conclusion: This project underscores that hemodialysis services in conflict-affected areas do not meet the standards for quality care. It emphasizes the necessity of implementing a comprehensive framework that engages relevant stakeholders in defining and upholding quality care, a model that should be extended to other protracted conflict-affected regions.
RESUMEN
Background: Tuberculosis (TB) is a chronic communicable disease caused by the Mycobacterium tuberculosis that thrives in protracted humanitarian crises. It is an important cause of morbidity and mortality burden in the developing world. Globally, TB is the number one cause of death from any single infectious disease agent that plagued an estimated 10 million (range, 8.9-11.0 million) people in 2019 alone. The Eastern Mediterranean region comprised 8.2% of the worldwide share of TB cases in 2019. Methods: in April 2019, the World Health Organization's (WHO) country office of Turkey started three TB centers in the cities of A'zaz, Idleb, and Afrin in northwest Syria, to provide the population with quality TB treatment curative services. The objectives of the project involved provision of full package of TB services in alignment with WHO TB standards and protocols. Three contractors i.e., national NGOs, were selected after a rigorous process in accordance with WHO policies. These newly established centers were equipped with the essential medical supplies, including well-functioning X-ray and microscopy laboratories run by WHO-trained medical doctors and lab technicians. Results: Based on the quarterly reports submitted by the WHO partners, from the last two quarters of the year 2019, and the four quarters for the year 2020, out of 785 cases diagnosed either by clinical, laboratory, or radiological assessment, 251 cases were bacteriologically confirmed as TB cases against the backdrop of 2236 bacteriological investigations done and a weekly average of 31 sputum specimens processed. A total of 316 smear positive slides were identified during the study period, with the proportion of smear positive slides to be 14.13%. Clinical status determined after 6 months of treatment revealed that out of the 181 patients enrolled in the third quarter of 2019, 128 patients were either cured or successfully completed their TB treatment; with a treatment success rate of 70.7% and in quarter 4, 2019 those figures were respectively: 133, 82 and 61.7%. Conclusion: Despite the challenging and protracted complex humanitarian situation in northwest Syria, the number of patients enrolled and the proportion who successfully completed the TB treatment is acceptable. However, these results are preliminary, as clinical outcomes were available only for the first and second cohorts of patients enrolled. Innovative solutions and flexibility in the execution and continued expansion of this promising project are imperative.
