Reference des cas de traumatisme par arme à feu en Afrique.

BACKGROUND: In a war-torn African country, Médecins Sans Frontières supports two regional referral hospitals to address emergencies, including the treatment of firearm-related traumas. It facilitates access to healthcare and referrals, which are often hindered due to non-medical reasons. OBJECTIVE: To determine the factors influencing the unfavourable outcome of cases referred for firearm trauma (December 2020-November 2021). METHOD: This was a cross-sectional study using routinely collected data. RESULTS: A total of 381 patients who were victims of firearm-related trauma were admitted, with an average age of 29 years; 28.3% had severe injuries, including thoraco-abdominal injuries and fractures. The mortality rate was 4.9%, and 7.9% left against medical advice. Patients affiliated with the irregular armed forces accounted for 45.4%, and had a two-thirds higher rate of unsuccessful referral for non-medical reasons. Patients with severe injuries at triage, affiliation with the irregular forces and being in the regular army had 2 times (P < 0.01), 5.9 times (P < 0.01) and 8.1 times (P < 0.01), respectively, a higher risk of an unfavourable outcome. CONCLUSION: Serious cases caused by firearm injuries were more likely to have an adverse outcome. The risk was higher in those with a specific affiliation, who were more often denied access to higher referral care based on socio-political rather than medical reasons.

Outcomes of cholera and measles outbreak alerts in the Democratic Republic of Congo.

SETTING: In 1995, a rapid response project for humanitarian and medical emergencies, including outbreak responses, named 'Pool d'Urgence Congo' (PUC), was implemented in the Democratic Republic of Congo by Médecins Sans Frontières. OBJECTIVE: To assess the outcomes of cholera and measles outbreak alerts that were received in the PUC surveillance system between 2016 and 2018. DESIGN: This was a retrospective cross-sectional study. RESULTS: Overall, 459 outbreak alerts were detected, respectively 69% and 31% for cholera and measles. Of these, 32% were actively detected and 68% passively detected. Most alerts (90%) required no intervention and 10% of alerts had an intervention. There were 25% investigations that were not carried out despite thresholds being met; 17% interventions were not performed, the main reported reason being PUC operational capacity was exceeded. Confirmed cholera and measles outbreaks that met an investigation threshold comprised respectively 90% and 76% of alerts; 59% of measles investigations were followed by a delayed outbreak response of ⩾14 days (n = 10 outbreaks). CONCLUSION: Some alerts for cholera and measles outbreaks that were detected in the PUC system did not lead to a response even when required; the main reported reason was limited operational capacity to respond to all of them.