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Mahmood H, Mckinstry B, Luz S, Fairhurst K, Nasim S, Hazir T. Community health worker-based mobile health (mHealth) approaches for improving management and caregiver knowledge of common childhood infections: A systematic review. J Glob Health 2020; 10:020438. [PMID: 33437462 PMCID: PMC7774026 DOI: 10.7189/jogh.10.020438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Children in lower middle-income countries (LMICs) are more at risk of dying, than those in High Income Countries (HICs), due to highly prevalent deadly yet preventable childhood infections. Alongside concerns about the incidence of these infections, there has been a renewed interest in involving community health workers (CHWs) in various public health programs. However, as CHWs are increasingly asked to take on different tasks there is a risk that their workload may become unmanageable. One solution to help reduce this burden is the use of mobile health (mHealth) technology in the community through behaviour change. Considering there are various CHWs based mHealth approaches on illness management and education, therefore, we aimed to appraise the available literature on effectiveness of these mHealth approaches for caregivers to improve knowledge and management about common under-five childhood infections with respect to behaviour change. Methods We searched six databases between October to December 2019 using subject heading (Mesh) and free text terms in title or abstract in US English. We included multiple study types of children under-five or their caregivers who have been counselled, educated, or provided any health care service by CHWs for any common paediatric infectious diseases using mHealth. We excluded articles published prior to 1990 and those including mHealth technology not coming under the WHO definition. A data extraction sheet was developed and titles, abstracts, and selected full text were reviewed by two reviewers. Quality assessment was done using JBI tools. Results We included 23 articles involving around 300 000 individuals with eight types of study designs. 20 studies were conducted in Africa, two in Asia, and one in Latin America mainly on pneumonia or respiratory tract infections followed by malaria and diarrhoea in children. The most common types of Health approaches were mobile applications for decision support, text message reminders and use of electronic health record systems. None of the studies employed the use of any behaviour change model or any theoretical framework for selection of models in their studies. Conclusions Coupling mhealth with CHWs has the potential to benefit communities in improving management of illnesses in children under-five. High quality evidence on impact of such interventions on behaviour is relatively sparse and further studies should be conducted using theoretically informed behaviour change frameworks/models. Registration PROPSERO Registration number: CRD42018117679
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Affiliation(s)
- Hana Mahmood
- Maternal, Neonatal and Child Health Research Network (MNCHRN), Pakistan.,NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Brian Mckinstry
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Saturnino Luz
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Karen Fairhurst
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Sumaira Nasim
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Tabish Hazir
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, the University of Edinburgh, Edinburgh, UK
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Baba E, Hamade P, Kivumbi H, Marasciulo M, Maxwell K, Moroso D, Roca-Feltrer A, Sanogo A, Stenstrom Johansson J, Tibenderana J, Abdoulaye R, Coulibaly P, Hubbard E, Jah H, Lama EK, Razafindralambo L, Van Hulle S, Jagoe G, Tchouatieu AM, Collins D, Gilmartin C, Tetteh G, Djibo Y, Ndiaye F, Kalleh M, Kandeh B, Audu B, Ntadom G, Kiba A, Savodogo Y, Boulotigam K, Sougoudi DA, Guilavogui T, Keita M, Kone D, Jackou H, Ouba I, Ouedraogo E, Messan HA, Jah F, Kaira MJ, Sano MS, Traore MC, Ngarnaye N, Elagbaje AYC, Halleux C, Merle C, Iessa N, Pal S, Sefiani H, Souleymani R, Laminou I, Doumagoum D, Kesseley H, Coldiron M, Grais R, Kana M, Ouedraogo JB, Zongo I, Eloike T, Ogboi SJ, Achan J, Bojang K, Ceesay S, Dicko A, Djimde A, Sagara I, Diallo A, NdDiaye JL, Loua KM, Beshir K, Cairns M, Fernandez Y, Lal S, Mansukhani R, Muwanguzi J, Scott S, Snell P, Sutherland C, Tuta R, Milligan P. Effectiveness of seasonal malaria chemoprevention at scale in west and central Africa: an observational study. Lancet 2020; 396:1829-1840. [PMID: 33278936 PMCID: PMC7718580 DOI: 10.1016/s0140-6736(20)32227-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/20/2020] [Accepted: 09/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) aims to prevent malaria in children during the high malaria transmission season. The Achieving Catalytic Expansion of SMC in the Sahel (ACCESS-SMC) project sought to remove barriers to the scale-up of SMC in seven countries in 2015 and 2016. We evaluated the project, including coverage, effectiveness of the intervention, safety, feasibility, drug resistance, and cost-effectiveness. METHODS For this observational study, we collected data on the delivery, effectiveness, safety, influence on drug resistance, costs of delivery, impact on malaria incidence and mortality, and cost-effectiveness of SMC, during its administration for 4 months each year (2015 and 2016) to children younger than 5 years, in Burkina Faso, Chad, The Gambia, Guinea, Mali, Niger, and Nigeria. SMC was administered monthly by community health workers who visited door-to-door. Drug administration was monitored via tally sheets and via household cluster-sample coverage surveys. Pharmacovigilance was based on targeted spontaneous reporting and monitoring systems were strengthened. Molecular markers of resistance to sulfadoxine-pyrimethamine and amodiaquine in the general population before and 2 years after SMC introduction was assessed from community surveys. Effectiveness of monthly SMC treatments was measured in case-control studies that compared receipt of SMC between patients with confirmed malaria and neighbourhood-matched community controls eligible to receive SMC. Impact on incidence and mortality was assessed from confirmed outpatient cases, hospital admissions, and deaths associated with malaria, as reported in national health management information systems in Burkina Faso and The Gambia, and from data from selected outpatient facilities (all countries). Provider costs of SMC were estimated from financial costs, costs of health-care staff time, and volunteer opportunity costs, and cost-effectiveness ratios were calculated as the total cost of SMC in each country divided by the predicted number of cases averted. FINDINGS 12 467 933 monthly SMC treatments were administered in 2015 to a target population of 3 650 455 children, and 25 117 480 were administered in 2016 to a target population of 7 551 491. In 2015, among eligible children, mean coverage per month was 76·4% (95% CI 74·0-78·8), and 54·5% children (95% CI 50·4-58·7) received all four treatments. Similar coverage was achieved in 2016 (74·8% [72·2-77·3] treated per month and 53·0% [48·5-57·4] treated four times). In 779 individual case safety reports over 2015-16, 36 serious adverse drug reactions were reported (one child with rash, two with fever, 31 with gastrointestinal disorders, one with extrapyramidal syndrome, and one with Quincke's oedema). No cases of severe skin reactions (Stevens-Johnson or Lyell syndrome) were reported. SMC treatment was associated with a protective effectiveness of 88·2% (95% CI 78·7-93·4) over 28 days in case-control studies (2185 cases of confirmed malaria and 4370 controls). In Burkina Faso and The Gambia, implementation of SMC was associated with reductions in the number of malaria deaths in hospital during the high transmission period, of 42·4% (95% CI 5·9 to 64·7) in Burkina Faso and 56·6% (28·9 to 73·5) in The Gambia. Over 2015-16, the estimated reduction in confirmed malaria cases at outpatient clinics during the high transmission period in the seven countries ranged from 25·5% (95% CI 6·1 to 40·9) in Nigeria to 55·2% (42·0 to 65·3) in The Gambia. Molecular markers of resistance occurred at low frequencies. In individuals aged 10-30 years without SMC, the combined mutations associated with resistance to amodiaquine (pfcrt CVIET haplotype and pfmdr1 mutations [86Tyr and 184Tyr]) had a prevalence of 0·7% (95% CI 0·4-1·2) in 2016 and 0·4% (0·1-0·8) in 2018 (prevalence ratio 0·5 [95% CI 0·2-1·2]), and the quintuple mutation associated with resistance to sulfadoxine-pyrimethamine (triple mutation in pfdhfr and pfdhps mutations [437Gly and 540Glu]) had a prevalence of 0·2% (0·1-0·5) in 2016 and 1·0% (0·6-1·6) in 2018 (prevalence ratio 4·8 [1·7-13·7]). The weighted average economic cost of administering four monthly SMC treatments was US$3·63 per child. INTERPRETATION SMC at scale was effective in preventing morbidity and mortality from malaria. Serious adverse reactions were rarely reported. Coverage varied, with some areas consistently achieving high levels via door-to-door campaigns. Markers of resistance to sulfadoxine-pyrimethamine and amodiaquine remained uncommon, but with some selection for resistance to sulfadoxine-pyrimethamine, and the situation needs to be carefully monitored. These findings should support efforts to ensure high levels of SMC coverage in west and central Africa. FUNDING Unitaid.
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Dieng S, Ba EH, Cissé B, Sallah K, Guindo A, Ouedraogo B, Piarroux M, Rebaudet S, Piarroux R, Landier J, Sokhna C, Gaudart J. Spatio-temporal variation of malaria hotspots in Central Senegal, 2008-2012. BMC Infect Dis 2020; 20:424. [PMID: 32552759 PMCID: PMC7301493 DOI: 10.1186/s12879-020-05145-w] [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: 06/25/2019] [Accepted: 06/10/2020] [Indexed: 12/01/2022] Open
Abstract
Background In malaria endemic areas, identifying spatio-temporal hotspots is becoming an important element of innovative control strategies targeting transmission bottlenecks. The aim of this work was to describe the spatio-temporal variation of malaria hotspots in central Senegal and to identify the meteorological, environmental, and preventive factors that influence this variation. Methods This study analysed the weekly incidence of malaria cases recorded from 2008 to 2012 in 575 villages of central Senegal (total population approximately 500,000) as part of a trial of seasonal malaria chemoprevention (SMC). Data on weekly rainfall and annual vegetation types were obtained for each village through remote sensing. The time series of weekly malaria incidence for the entire study area was divided into periods of high and low transmission using change-point analysis. Malaria hotspots were detected during each transmission period with the SaTScan method. The effects of rainfall, vegetation type, and SMC intervention on the spatio-temporal variation of malaria hotspots were assessed using a General Additive Mixed Model. Results The malaria incidence for the entire area varied between 0 and 115.34 cases/100,000 person weeks during the study period. During high transmission periods, the cumulative malaria incidence rate varied between 7.53 and 38.1 cases/100,000 person-weeks, and the number of hotspot villages varied between 62 and 147. During low transmission periods, the cumulative malaria incidence rate varied between 0.83 and 2.73 cases/100,000 person-weeks, and the number of hotspot villages varied between 10 and 43. Villages with SMC were less likely to be hotspots (OR = 0.48, IC95%: 0.33–0.68). The association between rainfall and hotspot status was non-linear and depended on both vegetation type and amount of rainfall. The association between village location in the study area and hotspot status was also shown. Conclusion In our study, malaria hotspots varied over space and time according to a combination of meteorological, environmental, and preventive factors. By taking into consideration the environmental and meteorological characteristics common to all hotspots, monitoring of these factors could lead targeted public health interventions at the local level. Moreover, spatial hotspots and foci of malaria persisting during LTPs need to be further addressed. Trial registration The data used in this work were obtained from a clinical trial registered on July 10, 2008 at www.clinicaltrials.gov under NCT00712374.
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Affiliation(s)
- Sokhna Dieng
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France. .,Ecole des Hautes Etudes en Santé Publique, Rennes, France.
| | - El Hadj Ba
- UMR VITROME, Campus International IRD-UCAD de l'IRD, Dakar, Sénégal
| | - Badara Cissé
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation (IRESSEF) Diamniadio, Dakar, Sénégal
| | - Kankoe Sallah
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France.,AP-HP, Hôpital Bichat, Unité de Recherche Clinique PNVS, Paris, France
| | - Abdoulaye Guindo
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France.,Research and Training Center - Ogobara K Doumbo, FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Boukary Ouedraogo
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France.,Direction des Systèmes d'Information en santé, Ministère de la santé, Ouagadougou, Burkina Faso
| | - Martine Piarroux
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France
| | - Stanislas Rebaudet
- APHM, Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Hôpital Européen, Marseille, France
| | - Renaud Piarroux
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France
| | - Cheikh Sokhna
- UMR VITROME, Campus International IRD-UCAD de l'IRD, Dakar, Sénégal
| | - Jean Gaudart
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistic & ICT, Marseille, France
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Dieng S, Michel P, Guindo A, Sallah K, Ba EH, Cissé B, Carrieri MP, Sokhna C, Milligan P, Gaudart J. Application of Functional Data Analysis to Identify Patterns of Malaria Incidence, to Guide Targeted Control Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114168. [PMID: 32545302 PMCID: PMC7312547 DOI: 10.3390/ijerph17114168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/16/2022]
Abstract
We introduce an approach based on functional data analysis to identify patterns of malaria incidence to guide effective targeting of malaria control in a seasonal transmission area. Using functional data method, a smooth function (functional data or curve) was fitted from the time series of observed malaria incidence for each of 575 villages in west-central Senegal from 2008 to 2012. These 575 smooth functions were classified using hierarchical clustering (Ward’s method), and several different dissimilarity measures. Validity indices were used to determine the number of distinct temporal patterns of malaria incidence. Epidemiological indicators characterizing the resulting malaria incidence patterns were determined from the velocity and acceleration of their incidences over time. We identified three distinct patterns of malaria incidence: high-, intermediate-, and low-incidence patterns in respectively 2% (12/575), 17% (97/575), and 81% (466/575) of villages. Epidemiological indicators characterizing the fluctuations in malaria incidence showed that seasonal outbreaks started later, and ended earlier, in the low-incidence pattern. Functional data analysis can be used to identify patterns of malaria incidence, by considering their temporal dynamics. Epidemiological indicators derived from their velocities and accelerations, may guide to target control measures according to patterns.
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Affiliation(s)
- Sokhna Dieng
- Sciences Economiques et Sociales de la Santé et Traitement de de l'Information Médicale (SESSTIM), Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche médicale (INSERM), Aix Marseille Université, 13005 Marseille, France
| | - Pierre Michel
- Aix Marseille School of Economics (AMSE), Centrale Marseille, Ecoles des Hautes Etudes en Sciences Sociales (EHESS), Centre National de la Recherche Scientifique (CNRS), Aix Marseille Université, 13001 Marseille, France
| | - Abdoulaye Guindo
- Sciences Economiques et Sociales de la Santé et Traitement de de l'Information Médicale (SESSTIM), Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche médicale (INSERM), Aix Marseille Université, 13005 Marseille, France
- Mère et Enfant face aux Infections Tropicales (MERIT), Institut de Recherche pour le Développement (IRD), Université Paris 5, 75006 Paris, France
| | - Kankoe Sallah
- Sciences Economiques et Sociales de la Santé et Traitement de de l'Information Médicale (SESSTIM), Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche médicale (INSERM), Aix Marseille Université, 13005 Marseille, France
- Unité de Recherche Clinique Paris Nord Val de Seine (PNVS), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP), 75018 Paris, France
| | - El-Hadj Ba
- Unité Mixte de Recherche (UMR), Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Campus International Institut de Recherche pour le Développement-Université Cheikh Anta Diop (IRD-UCAD) de l'IRD, Dakar CP 18524, Senegal
| | - Badara Cissé
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation (IRESSEF) Diamniadio, Dakar BP 7325, Senegal
| | - Maria Patrizia Carrieri
- Sciences Economiques et Sociales de la Santé et Traitement de de l'Information Médicale (SESSTIM), Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche médicale (INSERM), Aix Marseille Université, 13005 Marseille, France
| | - Cheikh Sokhna
- Unité Mixte de Recherche (UMR), Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Campus International Institut de Recherche pour le Développement-Université Cheikh Anta Diop (IRD-UCAD) de l'IRD, Dakar CP 18524, Senegal
| | - Paul Milligan
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Jean Gaudart
- Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille(APHM), INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistic and ICT, 13005 Marseille, France
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