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Abdulkarim S, John S, Garba T, Basason H, Balogun P, Kuye J. Perceptions of TB-HIV comorbidity among the Nomads in Adamawa State, Nigeria. BMC Public Health 2024; 24:1208. [PMID: 38693499 PMCID: PMC11061968 DOI: 10.1186/s12889-024-18414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/22/2024] [Indexed: 05/03/2024] Open
Abstract
The recalcitrance of Mycobacterium tuberculosis (MTB) to eradication was related to achieving a nonreplicating (dormant) state and the increasing global burden of HIV coinfection. Consequently, understanding the knowledge and perception of the population at risk of tuberculosis-HIV infection is essential to designing a strategy of intervention embraced by the target population. A cross-sectional study was conducted among Nomads in Adamawa State, Nigeria. A multistage sampling technique was employed to recruit consented participants. Self-administered questionnaires were used to gather the required information from 4 nomadic schoolteachers in each selected school. Data were entered into a Microsoft Excel sheet where trends and tables of collated data were developed. The findings show that only 13.5% of the participants expressed the correct perceptions of the complementary relationship between HIV and TB. More people in government employment (35%) understand the coexisting relationship of TB-HIV infections. At the same time, cattle herders and crop farmers who practice the prevalent occupation lack knowledge of TB-HIV relatedness. Across gender, only a proportion of males (14.8%) than females (10.5%) were more likely to show an understanding of the complementary association of HIV and TB, and this difference showed statistical significance (p = 0.0001). In conclusion, male gender, education at a degree or professional level, and employment with the government are factors associated with positive perceptions of TB/HIV relatedness. Thus, there is a need to intensify communication to educate Nomads on HIV and TB-related issues.
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Affiliation(s)
- Suraj Abdulkarim
- SUFABEL Community Development Initiative, Gombe, Gombe State, Nigeria
| | - Stephen John
- Janna Health Foundation, Yola, Adamawa State, Nigeria
| | - Tomon Garba
- Janna Health Foundation, Yola, Adamawa State, Nigeria
| | | | - Paul Balogun
- SUFABEL Community Development Initiative, Gombe, Gombe State, Nigeria.
| | - Joseph Kuye
- John Snow Inc. (JSI), TB DIAH Project, Abuja, Nigeria
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Shiferie F, Gebremedhin S, Andargie G, DelPizzo F, Belete K, Fenta TG. Spatial distribution of zero-dose children in Ethiopia: evidence for a targeted intervention from a large-scale cross-sectional evaluation survey. Front Pediatr 2024; 12:1337922. [PMID: 38638589 PMCID: PMC11025612 DOI: 10.3389/fped.2024.1337922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
Background Ethiopia is the fourth leading contributor to the global total of zero-dose children (those who lack the first dose of diphtheria-tetanus-pertussis containing vaccine) and has substantial regional variations in zero-dose children. This study explored the spatial pattern of zero-dose children aged 12-35 months in Ethiopia. Methods A survey was conducted in pastoralist regions, developing regions, newly-established regions, conflict-affected areas, underserved urban populations, hard-to-reach areas, internally displaced populations, and refugees. Spatial autocorrelation was measured using the Global Moran'sIstatistic. Getis-Ord Gi* statistics was applied to calculate the spatial variability of the high and low prevalence rates of zero-dose children. The spatial interpolation technique was also applied to estimate unknown values that fall between known values. Inverse distance weighting interpolation method was used to predict the risk of zero-dose children. ArcGIS version 10.8 was used for the spatial analysis. Results A total of 3,646 children aged 12-35 months were included in the study. The spatial distribution of zero-dose children in Ethiopia was non-random (Global Moran'sI = 0.178971, p < 0.001). According to the hotspot analysis, western, eastern and northern parts of Somali and western and central parts of Afar regions had the highest load of zero-dose children (hotspot areas) followed by the Northeastern part of Amhara and southeastern part of Oromia regions. On the other hand, Southern Nations, Nationalities, and Peoples, Sidama, and the Eastern part of the Southwest Ethiopia peoples regions were identified as cold spot areas. The spatial interpolation analysis corresponded with the hotspot analysis results where western and central parts of Afar and western, eastern and northern parts of Somali regions were identified as high-risk areas for zero-dose children. However, Addis Ababa, Dire Dawa, Harari, Southern Nations, Nationalities, and Peoples, Sidama, Southwest Ethiopia Peoples, and parts of Oromia were found to be low-risk areas for zero-dose children. Conclusion The spatial analysis identified that zero-dose children had a significant spatial variation across the study areas. High clusters of zero-dose children were detected in Afar and Somali regions. Implementing routine and mop-up vaccination campaigns in the identified hotspot areas will help Ethiopia to improve coverage and reduce immunization inequalities.
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Affiliation(s)
- Fisseha Shiferie
- Project HOPE Ethiopia Country Office, Addis Ababa, Ethiopia
- School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Frank DelPizzo
- Bill & Melinda Gates Foundation, Seattle, WA, United States
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Kleisner K, Pokorný Š, Černý V. Sexually dimorphic traits are associated with subsistence strategy in African faces from the Sahel/Savannah belt. Am J Hum Biol 2024; 36:e24008. [PMID: 37897188 DOI: 10.1002/ajhb.24008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES Previous research revealed that in some African populations, food-production strategies are associated with facial shape. Nomadic pastoralists living in the African Sahel/Savannah belt have a different facial morphology than their sedentary neighbors. We investigated whether the lifestyle associated with a subsistence pattern has an impact on sexual dimorphism in the facial structure. METHODS We employed several methods from geometric morphometrics and demonstrated such effect in four ethnically distinct populations that share the same geographic space. RESULTS We show that the facial traits which correlate with a subsistence strategy are systematically associated with levels of facial sex-typicality. In particular, we found that faces with more pronounced pastoralist features have on average more masculine facial traits and that this effect is more pronounced in men than in women. CONCLUSIONS In general, though, the magnitude of overall facial dimorphism does not differ between pastoralists and farmers. Pastoralists (in contrast to farmers) tend to have a more masculine facial morphology but facial differences between the sexes are in both groups the same.
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Affiliation(s)
- Karel Kleisner
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic
| | - Šimon Pokorný
- Department of Philosophy and History of Science, Faculty of Science, Charles University, Prague, Czech Republic
| | - Viktor Černý
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czech Republic
- Archaeogenetics Laboratory, Institute of Archaeology of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
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Shiferie F, Gebremedhin S, Andargie G, Tsegaye DA, Alemayehu WA, Fenta TG. Low Measles Vaccination Coverage and Spatial Analysis of High Measles Vaccination Dropout in Ethiopia's Underprivileged Areas. Vaccines (Basel) 2024; 12:328. [PMID: 38543962 PMCID: PMC10975481 DOI: 10.3390/vaccines12030328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/01/2024] Open
Abstract
(1) Background: Measles remains a major cause of disease and death worldwide, especially in the World Health Organization African Region. This study aimed to estimate the coverage of measles vaccinations and map the spatial distribution of measles vaccination dropout in Ethiopia; (2) Methods: A cross-sectional survey was conducted in Ethiopia's underprivileged areas. The study included 3646 mothers/caregivers of children. ArcGIS for the spatial analysis, Global Moran's I statistic for spatial autocorrelation, and Getis-Ord Gi* statistics for hot spot analysis were applied; (3) Results: Overall, coverages of measles-containing-vaccine first- and second-doses were 67% and 35%, respectively. Developing regions had the lowest coverages of measles-containing-vaccine first- and second-doses, 46.4% and 21.2%, respectively. On average, the measles vaccination dropout estimate was 48.3%. Refugees had the highest measles vaccination dropout estimate (56.4%). The hot spot analysis detected the highest burden of measles vaccination dropout mainly in the northeastern parts of Ethiopia, such as the Afar Region's zones 1 and 5, the Amhara Region's North Gondar Zone, and peripheral areas in the Benishangul Gumuz Region's Assosa Zone; (4) Conclusions: The overall measles vaccination coverages were relatively low, and measles vaccination dropout estimates were high. Measles vaccination dropout hot spot areas were detected in the northeastern parts of Ethiopia.
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Affiliation(s)
- Fisseha Shiferie
- Project HOPE Ethiopia Country Office, Addis Ababa P.O. Box 45, Ethiopia; (G.A.); (D.A.T.)
- School of Pharmacy, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia;
| | - Samson Gebremedhin
- School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia;
| | - Gashaw Andargie
- Project HOPE Ethiopia Country Office, Addis Ababa P.O. Box 45, Ethiopia; (G.A.); (D.A.T.)
| | - Dawit A. Tsegaye
- Project HOPE Ethiopia Country Office, Addis Ababa P.O. Box 45, Ethiopia; (G.A.); (D.A.T.)
| | | | - Teferi Gedif Fenta
- School of Pharmacy, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia;
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Meredith HR, Wesolowski A, Okoth D, Maraga L, Ambani G, Chepkwony T, Abel L, Kipkoech J, Lokoel G, Esimit D, Lokemer S, Maragia J, Prudhomme O’Meara W, Obala AA. Characterizing mobility patterns and malaria risk factors in semi-nomadic populations of Northern Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002750. [PMID: 38478562 PMCID: PMC10936864 DOI: 10.1371/journal.pgph.0002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
While many studies have characterized mobility patterns and disease dynamics of settled populations, few have focused on more mobile populations. Highly mobile groups are often at higher disease risk due to their regular movement that may increase the variability of their environments, reduce their access to health care, and limit the number of intervention strategies suitable for their lifestyles. Quantifying the movements and their associated disease risks will be key to developing interventions more suitable for mobile populations. Turkana, Kenya is an ideal setting to characterize these relationships. While the vast, semi-arid county has a large mobile population (>60%) and was recently shown to have endemic malaria, the relationship between mobility and malaria risk in this region has not yet been defined. Here, we worked with 250 semi-nomadic households from four communities in Central Turkana to 1) characterize mobility patterns of travelers and 2) test the hypothesis that semi-nomadic individuals are at greater risk of malaria exposure when migrating with their herds than when staying at their semi-permanent settlements. Participants provided medical and travel histories, demographics, and a dried blood spot for malaria testing before and after the travel period. Further, a subset of travelers was given GPS loggers to document their routes. Four travel patterns emerged from the logger data, Long Term, Transient, Day trip, and Static, with only Long Term and Transient trips being associated with malaria cases detected in individuals who carried GPS devices. After completing their trips, travelers had a higher prevalence of malaria than those who remained at the household (9.2% vs 4.4%), regardless of gender and age. These findings highlight the need to develop intervention strategies amenable to mobile lifestyles that can ultimately help prevent the transmission of malaria.
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Affiliation(s)
- Hannah R. Meredith
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Amy Wesolowski
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dennis Okoth
- Department of Health Services and Sanitation, Lodwar, Turkana County, Kenya
| | - Linda Maraga
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - George Ambani
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Lucy Abel
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Joseph Kipkoech
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Gilchrist Lokoel
- Department of Health Services and Sanitation, Lodwar, Turkana County, Kenya
| | - Daniel Esimit
- Department of Health Services and Sanitation, Lodwar, Turkana County, Kenya
| | - Samuel Lokemer
- Department of Health Services and Sanitation, Lodwar, Turkana County, Kenya
| | - James Maragia
- Department of Health Services and Sanitation, Lodwar, Turkana County, Kenya
| | - Wendy Prudhomme O’Meara
- Duke Global Health Institute, Durham, North Carolina, United States of America
- School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
- School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Andrew A. Obala
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
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Bile AS, Ali-Salad MA, Mahmoud AJ, Singh NS, Abdelmagid N, Sabahelzain MM, Checchi F, Mounier-Jack S, Nor B. Assessing Vaccination Delivery Strategies for Zero-Dose and Under-Immunized Children in the Fragile Context of Somalia. Vaccines (Basel) 2024; 12:154. [PMID: 38400137 PMCID: PMC10892412 DOI: 10.3390/vaccines12020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Somalia is one of 20 countries in the world with the highest numbers of zero-dose children. This study aims to identify who and where zero-dose and under-vaccinated children are and what the existing vaccine delivery strategies to reach zero-dose children in Somalia are. This qualitative study was conducted in three geographically diverse regions of Somalia (rural/remote, nomadic/pastoralists, IDPs, and urban poor population), with government officials and NGO staff (n = 17), and with vaccinators and community members (n = 52). The data were analyzed using the GAVI Vaccine Alliance IRMMA framework. Nomadic populations, internally displaced persons, and populations living in remote and Al-shabaab-controlled areas are three vulnerable and neglected populations with a high proportion of zero-dose children. Despite the contextual heterogeneity of these population groups, the lack of targeted, population-specific strategies and meaningful engagement of local communities in the planning and implementation of immunization services is problematic in effectively reaching zero-dose children. This is, to our knowledge, the first study that examines vaccination strategies for zero-dose and under-vaccinated populations in the fragile context of Somalia. Evidence on populations at risk of vaccine-preventable diseases and barriers to vital vaccination services remain critical and urgent, especially in a country like Somalia with complex health system challenges.
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Affiliation(s)
- Ahmed Said Bile
- Somali Institute for Development Research and Analysis (SIDRA), Garowe, Puntland State, Somalia; (M.A.A.-S.); (A.J.M.)
| | - Mohamed A. Ali-Salad
- Somali Institute for Development Research and Analysis (SIDRA), Garowe, Puntland State, Somalia; (M.A.A.-S.); (A.J.M.)
| | - Amina J. Mahmoud
- Somali Institute for Development Research and Analysis (SIDRA), Garowe, Puntland State, Somalia; (M.A.A.-S.); (A.J.M.)
- Department of Women’s and Children’s Health, Uppsala University, 753 10 Uppsala, Sweden;
| | - Neha S. Singh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (N.S.S.); (N.A.); (F.C.)
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Nada Abdelmagid
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (N.S.S.); (N.A.); (F.C.)
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Majdi M. Sabahelzain
- School of Health Sciences, Ahfad University for Women (AUW), Omdurman P.O. Box 167, Sudan;
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Francesco Checchi
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (N.S.S.); (N.A.); (F.C.)
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Sandra Mounier-Jack
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Barni Nor
- Department of Women’s and Children’s Health, Uppsala University, 753 10 Uppsala, Sweden;
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Abdihamid O, Rubagumya F, Vanderpuye V, Alemu HK, Omar A, Abdourahman H, Hammad N. Neglected cancer care needs among the nomadic pastoralist communities in sub-Saharan Africa: a call to action. BMJ Glob Health 2024; 9:e014207. [PMID: 38238024 PMCID: PMC10806913 DOI: 10.1136/bmjgh-2023-014207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Affiliation(s)
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Abeid Omar
- Department of Oncology and Nuclear Medicine, Kenyatta University Teaching Referral & Research Hospital, Nairobi, Kenya
| | - Houda Abdourahman
- Department of Pathology, Hopital De Balbala Cheiko, Djibouti, Djibouti
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Meredith HR, Wesolowski A, Okoth D, Maraga L, Ambani G, Chepkwony T, Abel L, Kipkoech J, Lokoel G, Esimit D, Lokemer S, Maragia J, O’Meara WP, Obala AA. Characterizing mobility patterns and malaria risk factors in semi-nomadic populations of Northern Kenya. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.06.23299617. [PMID: 38106223 PMCID: PMC10723563 DOI: 10.1101/2023.12.06.23299617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
While many studies have characterized mobility patterns and disease dynamics of individuals from settled populations, few have focused on more mobile populations. Highly mobile groups are often at higher disease risk due to their regular movement that may increase the variability of their environments, reduce their access to health care, and limit the number of intervention strategies suitable for their lifestyles. Quantifying the movements and their associated disease risks will be key to developing intervention strategies more suitable for mobile populations. Here, we worked with four semi-nomadic communities in Central Turkana, Kenya to 1) characterize mobility patterns of travelers from semi-nomadic communities and 2) test the hypothesis that semi-nomadic individuals are at greater risk of exposure to malaria during seasonal migrations than when staying at their semi-permanent settlements. From March-October, 2021, we conducted a study in semi-nomadic households (n=250) where some members traveled with their herd while others remained at the semi-permanent settlement. Participants provided medical and travel histories, demographics, and a dried blood spot for malaria testing before and after the travel period. Further, a subset of travelers was given GPS loggers to document their routes. Four travel patterns emerged from the logger data, Long Term, Transient, Day trip, and Static, with only Long Term and Transient trips being associated with malaria cases detected in individuals who carried GPS devices. After completing their trips, travelers had a higher prevalence of malaria than those who remained at the household (9.2% vs 4.4%), regardless of gender, age group, and catchment area. These findings highlight the need to develop intervention strategies amenable to mobile lifestyles that can ultimately help prevent the transmission of malaria.
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Affiliation(s)
| | - Amy Wesolowski
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dennis Okoth
- Department of Health Services and Sanitation, Turkana County, Kenya
| | - Linda Maraga
- Academic Model Providing Access to Healthcare, Eldoret, Uasin Gishu, Kenya
| | - George Ambani
- Academic Model Providing Access to Healthcare, Eldoret, Uasin Gishu, Kenya
| | - Tabitha Chepkwony
- Academic Model Providing Access to Healthcare, Eldoret, Uasin Gishu, Kenya
| | - Lucy Abel
- Academic Model Providing Access to Healthcare, Eldoret, Uasin Gishu, Kenya
| | - Joseph Kipkoech
- Academic Model Providing Access to Healthcare, Eldoret, Uasin Gishu, Kenya
| | - Gilchrist Lokoel
- Department of Health Services and Sanitation, Turkana County, Kenya
| | - Daniel Esimit
- Department of Health Services and Sanitation, Turkana County, Kenya
| | - Samuel Lokemer
- Department of Health Services and Sanitation, Turkana County, Kenya
| | - James Maragia
- Department of Health Services and Sanitation, Turkana County, Kenya
| | - Wendy Prudhomme O’Meara
- Duke Global Health Institute, Durham, North Carolina, USA
- School of Public Health, Moi University College of Health Sciences, Eldoret, Uasin Gishu, Kenya
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Andrew A. Obala
- School of Medicine, Moi University College of Health Sciences, Eldoret, Uasin Gishu, Kenya
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Tenaw LA, Kumsa H, Arage MW, Abera A, Hailu T, Mislu E. Assessment of Place of Delivery and Associated Factors among Pastoralists in Ethiopia: A Systematic Review and Meta-Analysis Evaluation. J Pregnancy 2023; 2023:2634610. [PMID: 38026544 PMCID: PMC10653963 DOI: 10.1155/2023/2634610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background Pastoralist communities rely on their livestock for at least 50% of their food supply and source of income. Home births raise the risk of maternal morbidity and death, whereas institutional births lessen the likelihood of difficulties during labor. Around 70% of labors in pastoralist regions of Ethiopia were assisted by traditional birth attendants. Methods Studies done from January 2004 to January 2023, accessed in PubMed, EMBASE, Medline, and other search engines, were included. PRISMA guidelines and JBI critical appraisal checklist were used to assure the quality of the review. Ten articles were included in this review. Data were extracted with Excel and exported to STATA 16 for analysis. Heterogeneity of literatures was evaluated using I2 statistics and publication bias using the Egger regression asymmetry test and the Duval and Tweedie trim-fill analysis. Statistical significance was declared at p value less than 0.05. Result The pooled estimate of institutional delivery among the pastoralist community in Ethiopia is 21.2% (95% CI: 16.2-26.1). Husbands who were involved to decide place of delivery (OR = 3.47; 95% CI: 1.61, 7.50), women with good knowledge of MCH services (OR = 2.283; 95% CI: 1.51, 3.44), women who had a positive attitude towards MCH services (OR = 1.69; 95% CI: 0.79, 3.6), availability of health institutions (OR = 2.6; 95% CI: 0.95, 7.20), and women who had an ANC follow-up (OR = 2.78; 95% CI: 2.07, 3.73) were higher institutional delivery prevalence among pastoralist women. Moreover, institutional delivery among women who were educated above the college level was more than two times (OR = 2.56; 95% CI: 1.985, 3.304) higher than among women who were not educated. Conclusion Pastoralist women in Ethiopia were found to be a disadvantaged group for institutional delivery at national level. Husband involvement, educational level, ANC visit, knowledge and attitude for MCH service, and health facility distance were identified to have significant association with institutional delivery.
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Affiliation(s)
- Lebeza Alemu Tenaw
- School of Public Health, College of Health Science, Woldia University, Ethiopia
| | - Henok Kumsa
- School of Midwifery, College of Health Science, Woldia University, Ethiopia
| | | | - Atitegeb Abera
- School of Public Health, College of Health Science, Woldia University, Ethiopia
| | - Tilahun Hailu
- School of Public Health, College of Health Science, Woldia University, Ethiopia
| | - Esuyawkal Mislu
- School of Midwifery, College of Health Science, Woldia University, Ethiopia
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Monolbaev K, Kosbayeva A, Lazzerini M. Mobile Vaccination Teams for Improving Vaccination Coverage in the Kyrgyz Republic: Results of a National Health System-Strengthening Project during the First Two Years of the COVID-19 Pandemic. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1681. [PMID: 37892344 PMCID: PMC10605049 DOI: 10.3390/children10101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
(1) Background: This implementation study reports on the results of the mobile vaccination teams' (MVTs) activities during the first two years of the COVID-19 pandemic in Kyrgyzstan, when other vaccination services were disrupted. (2) Methods: Through a national health system-strengthening project under an order of the Ministry of Health, in 2020, the number of MVTs was increased, focusing on internal immigrant settlements around the cities of Bishkek and Osh and geographically remote areas. MVTs provided free vaccination services. (3) Results: MVTs vaccinated a total of 125,289 and 158,047 children in 2020 and 2021, respectively. The higher contribution of MVTs to vaccination coverage was in children under 5 years of age, with the three top vaccines being IPV (8.9%), MMR (7%), and PCV (6.6%). In 2021, 13,000 children who had not received an IPV vaccination and 8692 children who had not received the Pentavalent vaccine (DPT-HBV-Hib) were reached. The number of cases of vaccine-preventable disease reported in official statistics has reduced over time. (4) Conclusions: MVTs increased vaccination coverage in Kyrgyzstan, in particular in remote regions and migrant settlements, where it accounted for a considerable proportion of the vaccinated. This study adds to previous evidence in the literature of the role of MVTs as a strategy to improve immunization in hard-to-reach populations, particularly children.
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Affiliation(s)
- Kubanychbek Monolbaev
- WHO Country Office, Bishkek 720040, Kyrgyzstan;
- United Nations Children’s Fund (UNICEF), 160 Chui Avenue, Bishkek 720040, Kyrgyzstan
| | - Alyia Kosbayeva
- WHO Regional Office for Europe, DK-2100 Copenhagen, Denmark;
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Nditanchou R, Dixon R, Atekem K, Biholong B, Wilhelm A, Selby R, Oye J, Kamgno J, Boakye D, Schmidt E, Senyonjo L. Ivermectin and doxycycline treatments against Onchocerciasis: Adaptations and impact among semi-nomadic population in Massangam Health District, Cameroon. PLoS Negl Trop Dis 2023; 17:e0011463. [PMID: 37437096 PMCID: PMC10365309 DOI: 10.1371/journal.pntd.0011463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/24/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
We trialed strategies to reach semi-nomadic population with interventions targeting onchocerciasis including a combination of community knowledge and Geographical Information System (GIS) technology; nomad-specific sensitization; and mobile outreach. The interventions included ivermectin (ivm) mass drug administration (MDA) and treating infected individuals (found upon skin snip microscopy test) with doxycycline for 35 days. Microscopy-negative snips were further tested by Polymerase Chain Reaction (PCR). After 8 months, individuals immigrating or emigrating constituted 47% of the initial population; 59% of individuals not born in the area have immigrated during the last five years; 28% (age>9) reportedly never taken ivm; 72% (compared to 51% previously) of eligible population (age ≥ 5 years) took ivm; and 47% (age > 8, not pregnant, not breastfeeding, not severely ill,) participated in the test. A high prevalence of onchocerciasis,15.1%, was found upon microscopy & PCR test; 9/10 tested by skin snip microscopy and PCR at follow-up were all negative. Microfilaria prevalence and intensity upon skin snip microscopy reduced significantly from baseline following the intervention (8.9% to 4.1%, p = 0.032; 0.18 to 0.16, p = 0.013, respectively). The strategies considerably increased reach to nomadic camps. Treating with doxycycline in combination with ivm is feasible and has led to a significant reduction in infection level within one year among the semi-nomads. Being potentially curative in one intervention round, this combination should be considered for population group faced with challenges of achieving adequate coverage and adhesion to ivm MDA over prolonged period (>10 years).
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Affiliation(s)
| | - Ruth Dixon
- Sightsavers, Haywards Heath Office, Haywards Heath, United Kingdom
| | - Kareen Atekem
- Sightsavers, Cameroon Country Office, Yaoundé, Cameroon
| | - Benjamin Biholong
- National Programme for the Fight against Onchocerciasis and Lymphatic Filariasis, Ministry of Public Health, Yaoundé, Cameroon
| | - Aude Wilhelm
- Sightsavers, Haywards Heath Office, Haywards Heath, United Kingdom
| | - Richard Selby
- Sightsavers, Haywards Heath Office, Haywards Heath, United Kingdom
| | - Joseph Oye
- Sightsavers, Cameroon Country Office, Yaoundé, Cameroon
| | - Joseph Kamgno
- Filariasis and other Neglected Tropical Diseases Research Center, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Daniel Boakye
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Elena Schmidt
- Sightsavers, Haywards Heath Office, Haywards Heath, United Kingdom
| | - Laura Senyonjo
- Sightsavers, Haywards Heath Office, Haywards Heath, United Kingdom
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12
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Yau IB, Zubair Mustapha M, Nwaze E, Nobila O, Maigoro A, Abdullah A, Gamawa A, Meissner P, Albrecht J, Müller O. Improving the timeliness and completeness of childhood vaccination through color-coded bracelets: a pilot study among Fulani tribe populations in Nigeria. J Public Health Afr 2023; 14:2079. [PMID: 37441119 PMCID: PMC10334432 DOI: 10.4081/jphia.2023.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 07/03/2022] [Indexed: 07/15/2023] Open
Abstract
Background Childhood immunization remains one of the most cost-effective public health interventions. Globally, millions of children are not being reached with safe and effective vaccines and Nigeria has the highest number of unprotected children. Objective The effects of locally adapted interventions on vaccination timeliness and completeness were studied amongst Fulani populations across 6 health facilities in 2 districts of Bauchi State, Nigeria. Methods The intervention group consisted of newborns who received 5-color-coded bracelets representing different immunization contacts, while the control group had no bracelets. Vaccination rates across contacts were followed for 11 months. In addition, mothers of children in the intervention group were voluntarily recruited as peer-to-peer mobilizers (PPM). Results In this study, 435 children were studied. Vaccination completeness was higher in the intervention group compared to the control group at all contacts during follow-up. The difference was most noticeable at the fifth contact, with 158/256 (62%) children in the intervention group completing, compared to 73/179 (41%) in the control group (P<0.0001). Vaccination timeliness was better in the intervention group compared to the control one, which reached statistical significance at the second and third vaccination contacts (P<0.05). 68% of women volunteered as PPM and recruited 82 additional children for vaccination. Conclusion This study demonstrated the feasibility of a composite intervention (bracelets and PPM) to increase the completeness and timeliness of childhood immunization and provided preliminary evidence for its efficacy among Fulani populations in Nigeria. Findings from this pilot study should be confirmed through a larger cluster randomized controlled trial.
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Affiliation(s)
- Inuwa Barau Yau
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Eric Nwaze
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Adamu Abdullah
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Adamu Gamawa
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Peter Meissner
- Department of Pediatrics and Adolescent Medicine, Ulm University, Germany
| | - Jahn Albrecht
- Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| | - Olaf Müller
- Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
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13
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Nditanchou R, Dixon R, Atekem K, Akongo S, Biholong B, Ayisi F, Nwane P, Wilhelm A, Basnet S, Selby R, Wanji S, Bakajika D, Oye J, Kamgno J, Boakye D, Schmidt E, Senyonjo L. Acceptability of test and treat with doxycycline against Onchocerciasis in an area of persistent transmission in Massangam Health District, Cameroon. PLoS Negl Trop Dis 2023; 17:e0011185. [PMID: 37018235 PMCID: PMC10075443 DOI: 10.1371/journal.pntd.0011185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/21/2023] [Indexed: 04/06/2023] Open
Abstract
The main onchocerciasis elimination strategy is annual Community-Directed Treatment with ivermectin (CDTi). However, as a response to persistent high infection prevalence in Massangam Health District in Cameroon, two rounds of alternative treatments including biannual CDTi, ground larviciding and test and treat with doxycycline (TTd) were implemented. This led to a significant prevalence reduction from 35.7% to 12.3% (p<0.001) as reported by Atekem and colleagues. Here we report on the acceptability of TTd component based on qualitative and quantitative data. The TTd involved microscopic examination for microfilaria in skin biopsy and those infected were offered doxycycline 100 mg daily for 35 days by community-directed distributors (CDDs). Participation level was significantly high with 54% of eligible population (age > 8, not pregnant, not breastfeeding, not severely ill,) participating in the test in each round, increasing to 83% over the two rounds. Factors associated with non-participation included mistrust, being female; being younger than 26 years; short stay in the community; and belonging to semi-nomadic sub population due to their remote and disperse settlement, discrimination, their non selection as CDD, and language and cultural barriers. Treatment coverage was high -71% in round 1 and 83% in round 2. People moving away between testing and treatment impacted treatment coverage. Some participants noted mismatch between symptoms and test result; and that ivermectin is better than doxycycline, while others favoured doxycycline. CDD worried about work burden with unmatching compensation. Overall, TTd participation was satisfactory. But can be improved through reinforcing sensitisation, reducing time between test and treatment; combining TTd and CDTi in one outing; augmenting CDDs compensation and/or weekly visit; exploring for frequently excluded populations and adapting strategies to reach them; and use of a sensitive less invasive test.
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Affiliation(s)
| | - Ruth Dixon
- Sightsavers, Haywards Heath, United Kingdom
| | | | | | - Benjamin Biholong
- National Programme for the Fight against Onchocerciasis and Lymphatic Filariasis, Ministry of Public Health, Yaoundé, Cameroon
| | - Franklin Ayisi
- National Programme for the Fight against Onchocerciasis and Lymphatic Filariasis, Ministry of Public Health, Yaoundé, Cameroon
| | - Philippe Nwane
- Filariasis and other Tropical Neglected Diseases Research Center, Yaoundé, Cameroon
| | | | | | | | - Samuel Wanji
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
- Department of Microbiology and Parasitology, University of Buea, Cameroon
| | - Didier Bakajika
- WHO/Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Joseph Oye
- Sightsavers, Cameroon Country Office, Cameroon
| | - Joseph Kamgno
- Filariasis and other Tropical Neglected Diseases Research Center, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Daniel Boakye
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Wulifan JK, Dordah AD, Sumankuuro J. Nomadic pastoralists' experience accessing reproductive and maternal healthcare services in low and middle-income countries: A contextual scoping review. PASTORALISM 2022. [DOI: 10.1186/s13570-022-00261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AbstractGlobally, discriminately vulnerable and marginalized groups, such as nomadic pastoralist populations, have perhaps the least access to reproductive and maternal health services (R/MHCSs). Previous studies report that most nomadic pastoralist mothers use both traditional methods of childbirth (i.e. delivering at home and assistance by traditional birth attendants (TBAs)) and traditional methods of contraception. However, determining factors of R/MHCSs in these nomadic pastoralist communities remain scarcely explored and condensed. This study aims to analyse quantitative, qualitative, and mixed methods studies and summarize pastoralists’ experience accessing R/MHCSs in low- and middle-income countries (LMICs).We employed a mixed method approach in conducting this scoping review by including studies applying quantitative, qualitative, and mixed methods retrieved from online databases (PubMed, Google Scholar, and JSTOR) as well as reviewing indexes of journals specific to the field by using a set of keywords related to R/MHCSs in LMICs. Thematic content analysis was performed to generate four themes and codes.We retrieved 2131 articles and retained 25 that met our inclusion criteria. Of these, 6 were quantitative studies, 12 were qualitative studies, and 7 were mixed methods studies. We found that nomadic pastoralists face multi-faceted barriers in access to R/MHCS that can be broadly categorized into four themes: (i) physical (geographic isolation and access), (ii) political (discriminatory/marginalized status, poor transport system, lack of infrastructure, and little political status to improve their lives), (iii) economic (poor quality of service/lack of available resources in rural areas where nomadic pastoralists live, vulnerability, poverty/affordability of R/MHCSs), and (iv) socio-cultural (misconceptions, perception, gender roles in decision-making, low demand for R/MHCSs by nomadic pastoralists, autonomy for females to travel) factors. Therefore, to effectively address the needs of nomadic pastoralist populations, R/MHCSs must be available, accessible, acceptable, and affordable through political, economic, geographic, and socio-culturally sensitive approaches.Low awareness of, and low access to, modern R/MHCSs and their benefits is a critical barrier to service utilization. Partnership with nomad communities through leveraging existing structures, networks, and decision-making patterns and involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key to R/MHCS access.What is known about this topic?
The utilization of a skilled attendant at birth has been improving amongst nomadic pastoralists but with significant variations across LMICs.
The experiences in accessing R/MHCs amongst pastoralist populations are not fully known.
What the study adds
Traditional delivery beds should be provided in health facilities because most nomadic women believe the sitting position during delivery speeds up the labour.
Static health facilities are not helpful for pastoralist lifestyles because they are inaccessible and culturally insensitive.
Female midwives are required in the health facilities to attract pastoralist women who abhor being attended to by male midwives. We also call for the need for culturally appropriate maternal care at healthcare facilities.
Conventional youth programming does not reach the large population of marginalized and disadvantaged nomadic girls who need reproductive health information and services. Innovative approaches considering the socio-cultural and economic environment can better address the nomadic youth’s reproductive health challenges.
In order to increase girls’ participation in reproductive health issues, it is important to create a safe environment for them and to involve their mothers in issues of sexual and reproductive health.
To successfully give nomadic girls and mothers a voice in their reproductive health requires the support of cultural leaders who give direction on various issues in the community.
Safe spaces and social networks for girls are potent strategies for RH advocacy at the community level.
Accessing FP methods is a problem mainly due to long distances to health facilities.
Some women are willing to use modern FP methods but encounter resistance from their male partners/husbands.
Traditional FP methods are popular because they are readily available, have no side effects, and are trusted.
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Karim A, de Savigny D, Awor P, Cobos Muñoz D, Mäusezahl D, Kitoto Tshefu A, Ngaima JS, Enebeli U, Isiguzo C, Nsona H, Ogbonnaya I, Ngoy P, Alegbeleye A. The building blocks of community health systems: a systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions. BMJ Glob Health 2022; 7:bmjgh-2022-008493. [PMID: 35772810 PMCID: PMC9247653 DOI: 10.1136/bmjgh-2022-008493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Almost all sub-Saharan African countries have adopted some form of integrated community case management (iCCM) to reduce child mortality, a strategy targeting common childhood diseases in hard-to-reach communities. These programs are complex, maintain diverse implementation typologies and involve many components that can influence the potential success of a program or its ability to effectively perform at scale. While tools and methods exist to support the design and implementation of iCCM and measure its progress, these may not holistically consider some of its key components, which can include program structure, setting context and the interplay between community, human resources, program inputs and health system processes. Methods We propose a Global South-driven, systems-based framework that aims to capture these different elements and expand on the fundamental domains of iCCM program implementation. We conducted a content analysis developing a code frame based on iCCM literature, a review of policy documents and discussions with key informants. The framework development was guided by a combination of health systems conceptual frameworks and iCCM indices. Results The resulting framework yielded 10 thematic domains comprising 106 categories. These are complemented by a catalogue of critical questions that program designers, implementers and evaluators can ask at various stages of program development to stimulate meaningful discussion and explore the potential implications of implementation in decentralised settings. Conclusion The iCCM Systems Framework proposed here aims to complement existing intervention benchmarks and indicators by expanding the scope and depth of the thematic components that comprise it. Its elements can also be adapted for other complex community interventions. While not exhaustive, the framework is intended to highlight the many forces involved in iCCM to help managers better harmonise the organisation and evaluation of their programs and examine their interactions within the larger health system.
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Affiliation(s)
- Aliya Karim
- University of Basel, Basel, Switzerland .,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Don de Savigny
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Cobos Muñoz
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Daniel Mäusezahl
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Jean Serge Ngaima
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ugo Enebeli
- Department of Community Medicine, University of Port Harcourt, Choba, Rivers State, Nigeria
| | - Chinwoke Isiguzo
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Society for Family Health Nigeria, Abuja, Nigeria
| | - Humphreys Nsona
- IMCI, Malawi Ministry of Health, Lilongwe, Central Region, Malawi
| | - Ikechi Ogbonnaya
- Department of Health, Planning, Research & Statistics, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Pascal Ngoy
- PROSANI, USAID, Washington, District of Columbia, USA
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16
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Adams MW, Sutherland EG, Eckert EL, Saalim K, Reithinger R. Leaving no one behind: targeting mobile and migrant populations with health interventions for disease elimination-a descriptive systematic review. BMC Med 2022; 20:172. [PMID: 35527246 PMCID: PMC9082871 DOI: 10.1186/s12916-022-02365-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mobile and migrant populations (MMPs) pose a unique challenge to disease elimination campaigns as they are often hard to survey and reach with treatment. While some elimination efforts have had success reaching MMPs, other campaigns are struggling to do so, which may be affecting progress towards disease control and elimination. Therefore, this paper reviews the literature on elimination campaigns targeting MMPs across a selection of elimination diseases-neglected tropical diseases, malaria, trypanosomiasis, polio, smallpox, and rinderpest. METHODS Through a systematic review process following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a three-person review team identified papers from databases, conference records, and citation searches using inclusion/exclusion criteria. Papers were divided into three key outcome domains during the synthetization process: (1) MMP movement patterns in East Africa including reasons for movement and consequences in terms of health outcomes and healthcare access; (2) MMP contribution to the transmission of disease across all geographies; (3) surveillance methods and treatment interventions used to implement programming in MMPs across all geographies. Experts in the field also provided supplemental information and gray literature to support this review. RESULTS The review identified 103 records which were descriptively analyzed using the outcome domains. The results indicate that in East Africa, there are various motivations for migration from economic opportunity to political unrest to natural disasters. Regardless of motivation, mobile lifestyles affect health service access such that MMPs in East Africa report barriers in accessing healthcare and have limited health knowledge. Often lower service delivery to these populations has resulted in higher disease prevalence. A minority of articles suggest MMPs do not pose challenges to reaching disease control and elimination thresholds. Finally, the literature highlighted surveillance methods (e.g., using satellite imagery or mobile phone data to track movement, participatory mapping, snowball sampling) and intervention strategies (e.g., integration with animal health campaigns, cross-border coordination, alternative mass drug administration [MDA] methods) to implement health interventions in MMPs. CONCLUSIONS Ultimately, the literature reviewed here can inform programmatic decisions as the community attempts to reach these never treated populations. SYSTEMATIC REVIEW REGISTRATION The protocol for this manuscript was registered with the International Prospective Registry of Systematic Reviews (PROSPERO) (No. CRD42021214743).
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Affiliation(s)
- Molly W Adams
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
| | - Elizabeth G Sutherland
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
| | - Erin L Eckert
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
| | - Khalida Saalim
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
| | - Richard Reithinger
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
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17
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Asmare Atalell K, Asmare Techane M, Adugna Wubneh C, Tezera Assimamaw N, Mulualem Belay G, Tarik Tamir T, Bilal Muhye A, Guadie Kassie D, Wondim A, Terefe B, Tigabu Tarekegn B, Seid Ali M, Fentie B, Tefera Gonete A, Tekeba B, Fisiha Kassa S, Kassahun Desta B, Tilahun Dessie M, Getaneh Alemu T. Spatiotemporal distributions of immunization coverage in Ethiopia from 2000 to 2019. Vaccine 2022; 40:1413-1420. [PMID: 35125222 DOI: 10.1016/j.vaccine.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vaccination is the most important mechanism to improve childhood survival. However, immunization coverage is very low and unevenly distributed throughout the country. Therefore, this study was aimed to investigate the spatiotemporal distribution of immunization coverage in Ethiopia. METHOD Immunization coverage data and geospatial covariates data were obtained from EDHS 2000 to 2019 and different publicly available sources. A Bayesian geostatistic model was used to estimate the national immunization coverage at a pixel level and to identify factors associated with the spatial clustering of immunization coverages. RESULT The overall immunization coverage in Ethiopia was 38.7%, 36.55%, 51.8%, 67.1% and 66.9% for 2000, 2005, 2011, 2016 and 2019 respectively. Spatial clustering of low immunization coverage was observed in Eastern, Southern, Southwestern, Southeastern and Northeastern parts of Ethiopia in EDHSs. The altitude of the area was positively associated with immunization coverage in 2000, 2005 and 2019 EDHS. The population density was positively associated with immunization coverage in 2000, 2005, 2011 and 2016. Precipitation is also positively associated with immunization coverage in 2016. Moreover, mean annual temperature was positively associated with immunization coverage in 2000, 2005 and 2019 EDHSs. Travel time to the nearest city is negatively associated with immunization coverage in 2000, 2005, 2011 and 2016. Likewise, distance to health facilities was negatively associated with immunization coverage in all the five EDHSs. CONCLUSION This study found that immunization coverage in Ethiopia substantially varied across the subnational and local levels. Spatial clustering of low immunization coverage was observed in Southern, Southeastern, Southwestern, Northeastern, and Eastern parts of the country. Altitude, population density, precipitation, temperature, travel time to the nearest city in minutes, and distance to the health facilities were factors that affect the spatial clustering of immunizations coverage. These findings can guide policymakers in Ethiopia to design geographically targeted interventions to increase programs to achieve maximum immunization coverage.
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Affiliation(s)
- Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getaneh Mulualem Belay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addis Bilal Muhye
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Destaye Guadie Kassie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Wondim
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bethelihem Tigabu Tarekegn
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beletech Fentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Selam Fisiha Kassa
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bogale Kassahun Desta
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tilahun Dessie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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18
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Kelly RF, Jennings A, Hunt J, Hamman SM, Mazeri S, Nkongho EF, Ngwa VN, Tanya V, Sander M, Ndip L, Bessell PR, Morgan KL, Handel IG, Muwonge A, Bronsvoort BMDC. The epidemiology of bacterial zoonoses in pastoral and dairy cattle in Cameroon, Central Africa. Zoonoses Public Health 2021; 68:781-793. [PMID: 34129288 DOI: 10.1111/zph.12865] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 01/22/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
Previous work identified that bacterial zoonoses (Brucella species, Coxiella burnetii and Leptospira hardjo) were present in Cameroonian pastoral cattle. To assess the characteristics of this zoonotic risk, we analyse seroprevalence of each pathogen and the associated management, herd and environmental factors in Cameroonian pastoral and dairy cattle. Cross-sectional samples included pastoralist herds in the Northwest Region (NWR n = 750) and Vina Division (VD n = 748) and small holder dairy herds in the NWR (n = 60). Exposure to Brucella spp., C. burnetii and L. hardjo were screened for using commercial ELISAs and population adjusted estimates made. In addition, individual, herd and ecological metadata were collected and used to identify risk factors associated with animal-level seropositivity. In the pastoral cattle, seroprevalence to Brucella spp. was relatively low but was higher in the NWR (4.2%, CI: 2.5%-7.0%) than the VD (1.1%: CI 0.5%-2.4%), while L. hardjo seroprevalence was much higher though similar in the NWR (30.7%, CI 26.3%-35.5%) and VD (35.9%, CI 31.3%-40.7%). No differences were noted in C. burnetii seroprevalence between the two study sites (NWR: 14.6%, CI 11.8%-18.0%. VD: 12.4%, 9.6%-15.9%). Compared to pastoral, dairy cattle had lower seroprevalences for L. hardjo (1.7%, CI: 0.0%-4.9%), C. burnetii (0.0%, CI 0.0%-6.0%) but similar for Brucella spp. (5.0%, CI 0.0%-10.6%). Increased odds of Brucella spp. seropositivity were associated with owning sheep or rearing sheep and fencing cattle in at night. Adult cattle had increased odds of being seropositive for both C. burnetii and L. hardjo. Additionally, exposure to C. burnetii was associated with local ecological conditions and L. hardjo was negatively associated with cattle undertaking transhumance. This work highlights that exposure to these 3 important production diseases and occupational zoonoses are widespread in Cameroonian cattle. Further work is required to understand transmission dynamics between humans and livestock to inform implementation of effective control measures.
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Affiliation(s)
- Robert F Kelly
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Amy Jennings
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Jennifer Hunt
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Saidou M Hamman
- Regional Centre of Wakwa, Institute of Agricultural Research for Development, Ngaoundere, Cameroon
| | - Stella Mazeri
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Egbe F Nkongho
- School of Life Sciences, University of Lincoln, Lincoln, UK
| | - Victor N Ngwa
- School of Veterinary Sciences, University of Ngaoundere, Ngaoundere, Cameroon
| | | | - Melissa Sander
- Tuberculosis Reference Laboratory Bamenda, Hospital Roundabout, Bamenda, Cameroon
| | - Lucy Ndip
- Laboratory of Emerging Infectious Diseases, University of Buea, Buea, Cameroon
| | - Paul R Bessell
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Kenton L Morgan
- Institute of Ageing and Chronic Disease and School of Veterinary Science, University of Liverpool, Neston, UK
| | - Ian G Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Adrian Muwonge
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Barend M de C Bronsvoort
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
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Kenny L, Hassan R, Bacchus LJ, Smith M, Shell-Duncan B, Dagadu NA, Muriuki A, Aden AH, Jelle IA, Cislaghi B, Hossain M. Reproductive health decision making among nomadic pastoralists in North Eastern Kenya: a qualitative social network analysis. Reprod Health 2021; 18:108. [PMID: 34039368 PMCID: PMC8157425 DOI: 10.1186/s12978-021-01164-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To our knowledge, no studies exist on the influence of nomadic pastoralist women's networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). METHODS Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. RESULTS Women named 10-12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. CONCLUSIONS Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women's networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women's wider networks.
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Affiliation(s)
- Leah Kenny
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
- Present Address: Centre for Women, Peace & Security, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Rahma Hassan
- Institute for Development Studies, University of Nairobi, 4 Harry Thuku Rd, Nairobi, Kenya
| | - Loraine J. Bacchus
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
| | - Matthew Smith
- The Business School, Edinburgh Napier University, Edinburgh, EH14 1DJ UK
| | - Bettina Shell-Duncan
- Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100 USA
| | - Nana Apenem Dagadu
- Save the Children US, 899 North Capitol St NE, Suite 900, Washington, DC 20002 USA
| | - Angela Muriuki
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Abdullahi Hussein Aden
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Ibrahim Abdirizak Jelle
- Save the Children Kenya, Matundu Close, Off School Lane, Westlands, P.O. Box 39664-00623, Nairobi, Kenya
| | - Beniamino Cislaghi
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
| | - Mazeda Hossain
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Saint Pancras, London, WC1H 9SH UK
- Present Address: Centre for Women, Peace & Security, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
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Ahmed AH, Mohamed G, Okeibunor J, Onuekwusi I, Mkanda P, Okiror S. Strategies to Reach Nomadic Children During Polio SIAs: Experience in Dadaab and Fafi Sub-Counties of Kenya after the 2013-2014 Polio Outbreak. ACTA ACUST UNITED AC 2021; Spec Issue:1110. [PMID: 33954305 PMCID: PMC8096539 DOI: 10.29245/2578-3009/2021/s2.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Poliomyelitis, often called polio is a viral paralytic disease caused by Polioviruses. Although all susceptible individuals are at risk of getting infected, only about 1% become paralyzed. During the 2013 Polio Outbreak in Garissa County in Kenya, 50% of the confirmed cases were from the nomadic population although it comprises of only less than 20% of the total population in the county. Following concerns from the Horn of Africa Polio Technical Advisory Group (TAG) regarding inadequate vaccine coverage of nomadic population, several strategies were put in place to improve coverage and Acute Flaccid Paralysis case reporting among nomads in the rest of the planned 2014 polio vaccination campaigns. We describe strategies initiated from April 2014 by the Ministry of Health and partners to reach children in nomadic settlement in the two sub-counties of Dadaab and Fafi of Garissa County. Methods The strategies involved improving the mapping and tracking of the nomadic population by establishing lists of nomadic settlements obtained from local clan leaders and government administrators, their <5-year-old populations and focal persons. Focal persons were used to mobilise residents in their respective settlements and guide vaccination teams during campaigns. Settlement leaders were sensitised to report cases of Acute Flaccid Paralysis. In remote hamlets, trained community health volunteers were used as vaccinators. In such places drugs for common illness were also provided during the campaigns. A tracking tool to monitor nomadic population movement and special tally sheets to capture data were created. Training of vaccination personnel and intense social mobilisation activities was done. Results and conclusion About 2,000 additional children, from both nomadic and non-nomadic areas were reached when the new initiatives were started. For the first time, an actual number of nomadic children accessed was documented. Suspected AFP cases continued to be reported from nomadic settlements, and the number of zero dose children among the nonpolio AFP cases dropped. With modification and improvement, these strategies may be used to take health services such as routine immunisation to nomadic communities and reduce their vulnerability to vaccine preventable disease outbreaks.
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Affiliation(s)
| | | | | | | | - Pascal Mkanda
- WHO Regional Office for Africa (WHO AFRO), Brazzaville, Congo
| | - Samuel Okiror
- WHO Horn of Africa Coordination Office (HOA), Nairobi KENYA
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21
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Andersson SR, Hassanen S, Momanyi AM, Onyango DK, Gatwechi DK, Lutukai MN, Aura KO, Mungai AM, Chandani YK. Using Human-Centered Design to Adapt Supply Chains and Digital Solutions for Community Health Volunteers in Nomadic Communities of Northern Kenya. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:S151-S167. [PMID: 33727327 PMCID: PMC7971376 DOI: 10.9745/ghsp-d-20-00378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/12/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Unreliable and nonexistent supply chain procedures and processes are one of the primary barriers to achieving functional community health units in nomadic communities in the arid/semiarid counties of Kenya. METHODS We used a human-centered design (HCD) approach to engage communities and community health volunteers (CHVs) in redesigning a proven data-centric supply chain approach that included a digital solution, called cStock, for this challenging context. We conducted the HCD process in 4 phases: (1) understanding intent, (2) research and insights, (3) ideation and prototyping, and (4) supply chain design and requirements building. Data collection used qualitative methods and involved a range of stakeholders including CHVs, supervisors, and local beneficiaries. CHVs and their supervisors also participated in cStock usability testing. Drawing on insights and personas generated from the research, stakeholders ideated and codesigned supply chain tools. RESULTS The research identified critical insights for informing the redesign of cStock for nomadic communities. These insights were categorized into supply chain, information systems, human resources, behaviors, service delivery infrastructure, and connectivity. Four supply chain data solutions were designed, prototyped, tested, and iterated: a stock recording paper-based form, a user-friendly cStock application, a supervisor cStock application, and an unstructured supplementary service data reporting system using feature phones. CONCLUSIONS Using the HCD process incorporated the perspective of CHVs and their communities and provided key insights to inform the design of the supply chain and adapt cStock. The process helped make cStock to be inclusive and have the potential to have a meaningful impact on strengthening the supply chain for seminomadic and nomadic communities in northern Kenya. A strong supply chain for these CHVs will increase access to essential and reproductive health commodities and contribute to improving the overall health and well-being of these communities, especially women and children.
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Affiliation(s)
| | | | | | | | | | | | - Karen O Aura
- Ministry of Health Republic of Kenya, Nairobi, Kenya
| | - Alex M Mungai
- Ministry of Health Republic of Kenya, Nairobi, Kenya
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22
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Sangare M, Coulibaly YI, Coulibaly SY, Dolo H, Diabate AF, Atsou KM, Souleymane AA, Rissa YA, Moussa DW, Abdallah FW, Dembele M, Traore M, Diarra T, Brieger WR, Traore SF, Doumbia S, Diop S. Factors hindering health care delivery in nomadic communities: a cross-sectional study in Timbuktu, Mali. BMC Public Health 2021; 21:421. [PMID: 33639923 PMCID: PMC7916290 DOI: 10.1186/s12889-021-10481-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 02/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations’ characteristics, determine their perception on the current health services, and identify issues associated with community-based health interventions. Methods To develop a better health policy and strategic approaches adapted to nomadic populations, we conducted a cross-sectional study in the region of Timbuktu to describe the difficulties in accessing health services. The study consisted in administering questionnaires to community members in the communes of Ber and Gossi, in the Timbuktu region, to understand their perceptions of health services delivery in their settings. Results We interviewed 520 individuals, all members of the nomadic communities of the two study communes. Their median age was 38 years old with extremes ranging from 18 to 86 years old. Their main activities were livestock breeding (27%), housekeeping (26.4%), local trading (11%), farming (6%) and artisans (5.5%). The average distance to the local health center was 40.94 km and 23.19 km respectively in Gossi and Ber. In terms of barriers to access to health care, participants complained mainly about the transportation options (79.4%), the quality of provided services (39.2%) and the high cost of available health services (35.7%). Additionally, more than a quarter of our participants stated that they would not allow themselves to be examined by a health care worker of the opposite gender. Conclusion This study shows that nomadic populations do not have access to community-based health interventions. A number of factors were revealed to be important barriers per these communities’ perception including the quality of services, poverty, lifestyle, gender and current health policy strategies in the region. To be successful, future interventions should take these factors into account by adapting policies and methods. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10481-w.
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Affiliation(s)
- Moussa Sangare
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali. .,Interdisciplinary School of Health Sciences
- Faculty of Health Sciences, University of Ottawa, 75, av. Laurier Est, Ottawa ON K1N 6N5, Canada.
| | - Yaya Ibrahim Coulibaly
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Siaka Yamoussa Coulibaly
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Housseini Dolo
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Abdoul Fatao Diabate
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Kueshivi Midodji Atsou
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Abdoul Ag Souleymane
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Youssouf Ag Rissa
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Dada Wallet Moussa
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Fadimata Wallet Abdallah
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Massitan Dembele
- General Directorate of Health and Public Hygiene, Ministry of Health and Social Affairs of Mali, Bamako, Mali
| | - Mahamadou Traore
- General Directorate of Health and Public Hygiene, Ministry of Health and Social Affairs of Mali, Bamako, Mali
| | - Tieman Diarra
- World Health Organization (WHO), Regional Office for Africa, Cite du Djoue, PO Box 06, Brazzaville, Congo
| | - William R Brieger
- Department of International Health, Health System Program, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Sekou Fantamady Traore
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Seydou Doumbia
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Samba Diop
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
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Muga GO, Onyango-Ouma W, Sang R, Affognon H. Indigenous knowledge of Rift Valley Fever among Somali nomadic pastoralists and its implications on public health delivery approaches in Ijara sub-County, North Eastern Kenya. PLoS Negl Trop Dis 2021; 15:e0009166. [PMID: 33617555 PMCID: PMC7932528 DOI: 10.1371/journal.pntd.0009166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/04/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022] Open
Abstract
Rift Valley Fever (RVF) is a zoonotic disease whose outbreak results in heavy economic and public health burdens. In East Africa, RVF is mainly experienced in arid and semi-arid areas predominantly inhabited by the pastoralists. These areas experience sudden, dramatic epidemics of the disease at intervals of approximately 10 years, associated with widespread flooding and the resultant swarms of mosquitoes. Pastoralists’ indigenous knowledge and experience of RVF is critical for public health interventions targeting prevention and control of RVF. The study adopted a descriptive cross-sectional design combining both quantitative and qualitative methods of data collection. A total of 204 respondents participated in questionnaire survey and 15 key informants and 4 focus group discussions were interviewed and conducted respectively. In addition, secondary data mainly journal publications, books, policy documents and research reports from conferences and government departments were reviewed. Findings indicated that the Somali pastoralists possess immense knowledge of RVF including signs and symptoms, risk factors, and risk pathways associated with RVF. Ninety eight percent (98%) of respondents identified signs and symptoms such as bloody nose, diarrhea, foul smell and discharge of blood from the orifices which are consistent with RVF. Heavy rains and floods (85%) and sudden emergence of mosquito swarms (91%) were also cited as the major RVF risk factors while mosquito bites (85%), drinking raw milk and blood (78%) and contact with animal fluids during mobility, slaughter and obstetric procedures (77%) were mentioned as the RVF entry risk pathways. Despite this immense knowledge, the study found that the pastoralists did not translate the knowledge into safer health practices because of the deep-seated socio-cultural practices associated with pastoralist production system and religious beliefs. On top of these practices, food preparation and consumption practices such as drinking raw blood and milk and animal ritual sacrifices continue to account for most of the mortality and morbidity cases experienced in humans and animals during RVF outbreaks. This article concludes that pastoralists’ indigenous knowledge on RVF has implications on public health delivery approaches. Since the pastoralists’ knowledge on RVF was definitive, integrating the community into early warning systems through training on reporting mechanisms and empowering the nomads to use their mobile phone devices to report observable changes in their livestock and environment could prove very effective in providing information for timely mobilization of public health responses. Public health advocacy based on targeted and contextually appropriate health messaging and disseminated through popular communication channels in the community such as the religious leaders and local radio stations would also be needed to reverse the drivers of RVF occurrence in the study area. Rift Valley Fever is a viral disease that affects both humans and animals. It is categorized as one of the re-emerging and neglected tropical diseases that mainly affects the poor and marginalized populations that lack access to health services and are readily ignored. Humans usually get RVF through bites from infected mosquitoes. Infections also occur when humans are exposed to the body fluids, or tissues of infected animals. Hence the risk of infection is greatest when slaughtering in the context of traditional sacrificial practices. This is the major reason outbreak of RVF is commonly associated with people whose livelihoods revolve around livestock rearing. In East Africa, RVF is mainly experienced in arid and semi-arid areas predominantly inhabited by the pastoralists. These areas experience epidemics of the disease at intervals of approximately 10 years associated with Elnino events. Understanding the knowledge base of the people in terms of RVF signs and symptoms and risk factors and pathways is important for the adoption of effective prevention and control measures. This study findings suggest that even though the Somali nomads are adept at recognizing RVF, this knowledge has not been translated into appropriate health practices due to the deep-seated socio-cultural practices. Hence, there is need for health authorities to mount locally appropriate public health advocacy campaigns, empower the livestock keepers to report observable changes in livestock and environment using their mobile phone devices and promote cross-disciplinary studies on RVF.
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Affiliation(s)
- Geoffrey Otieno Muga
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
- * E-mail:
| | - Washington Onyango-Ouma
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Rosemary Sang
- International Centre for Insect Physiology and Ecology (ICIPE), Nairobi, Kenya
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Fazal O, Hotez PJ. NTDs in the age of urbanization, climate change, and conflict: Karachi, Pakistan as a case study. PLoS Negl Trop Dis 2020; 14:e0008791. [PMID: 33180793 PMCID: PMC7660527 DOI: 10.1371/journal.pntd.0008791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Owais Fazal
- Rice University, Houston, Texas, United States of America
| | - Peter J Hotez
- Departments of Pediatrics and Molecular Virology and Microbiology, Texas Children's Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Hagler Institute for Advanced Study at Texas A&M University, College Station, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- James A Baker III Institute of Public Policy, Rice University, Houston, Texas, United States of America
- Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, Texas, United States of America
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Bounedjar A, Benkali R, Badoui L, Abada M, Moumeni A, Marouani A, Sedkaoui C, Ammour H, Dib A, Braikia S, Reggad R, Zidane H, Taieb L, Mahfouf H, Belacel A, Mechiat Z, Maachou Y, Souilah S, Gamaz M, Reguig F, Tabouri S, Bouannika M, Ghomari S, Rostane A, Ougdi W, Belbachir L, Bousahba A, Seghier F, Megaiz A, Mesli Mohamed A, Gharnaout M, Ihadadenne D, Bensalem A, Namous Anissa S, Djeghim S, Khelifi Touhami S, Bouzid K, Kerboua E, Oukkal M, Hadjam F, Smaili F, Bekkouche S, Zidouni N, Mekideche D, Mebrek A, Douagui H, Abdelaziz R, Lemdani M, Malki G, Fissah A, Larbaoui B, Sadji N, Zeroual S, Filali T, Ayadi L, Youcef Ali L, Djebbar A, Heddane R, Haddad B, Djedi H, Yousfi A, Debbah L, Boualga K, Ouali L, Guettaf Fatima Z, Moussei A, Houri M, Haddouche A, Kedar M. Incidence of lung cancer in males and females in Algeria: The lung cancer registry in Algeria (LuCaReAl). Cancer Epidemiol 2020; 69:101799. [PMID: 32977217 DOI: 10.1016/j.canep.2020.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lung cancer is a major cause of death worldwide. However, few data on incidence, histologic types and mortality rates of lung cancer were available for Algeria. METHODS LuCaReAl is an ongoing descriptive, non-interventional, national, multicenter, prospective and longitudinal study conducted in Algeria, among oncologists and pulmonologists in public community and university hospitals. Median and interquartile ranges are displayed. RESULTS Between July 2016 and July 2017, 897 patients were included. Overall incidence of lung cancer was 3.4 [3.2;3.6] cases per 100,000 inhabitants; overall incidence by sex was 5.8 [5.4;6.2] for males and 1.0 [0.8;1.1] for females. Adenocarcinoma was the most common histologic type of cancer. Most tumors were diagnosed at Stage IV. CONCLUSION The first results from the LuCaReAl study in Algeria showed that most patients are diagnosed with lung cancer at an advanced stage. The ongoing follow-up will next provide data on the survival and mortality rates.
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Affiliation(s)
- Adda Bounedjar
- University of Blida 1, Faculty of Medicine, BP 270, Route de soumaa, Blida, Algeria.
| | - Radjâa Benkali
- University of Blida 1, Faculty of Medicine, BP 270, Route de soumaa, Blida, Algeria
| | - Louisa Badoui
- University of Blida 1, Faculty of Medicine, BP 270, Route de soumaa, Blida, Algeria
| | - Mohamed Abada
- University of Blida 1, Faculty of Medicine, BP 270, Route de soumaa, Blida, Algeria
| | - Abdelhak Moumeni
- Department of Pneumology, Center University of Setif, Mohamed Abdenour Street, 19000 Setif, Algeria
| | - Amina Marouani
- Department of Pneumology, Center University of Setif, Mohamed Abdenour Street, 19000 Setif, Algeria
| | - Chérifa Sedkaoui
- Department of Medical Oncology, Center University of Tizi Ouzou, Lamali Ahmed Street, 15000 Tizi Ouzou, Algeria
| | - Hayet Ammour
- Department of Medical Oncology, Center University of Tizi Ouzou, Lamali Ahmed Street, 15000 Tizi Ouzou, Algeria
| | - Adlane Dib
- Department of Medical Oncology, CAC Setif, 19000 Setif, Algeria
| | - Syhem Braikia
- Department of Medical Oncology, CAC Setif, 19000 Setif, Algeria
| | - Rime Reggad
- Department of Medical Oncology, CAC Setif, 19000 Setif, Algeria
| | - Habib Zidane
- Department of Medical Oncology, CAC Setif, 19000 Setif, Algeria
| | - Lamia Taieb
- Department of Medical Oncology, CAC Setif, 19000 Setif, Algeria
| | - Hassen Mahfouf
- Department of Medical Oncology, Public Hospital Rouiba Larbi Abdelsalem Street, 16000 Algiers, Algeria
| | - Amel Belacel
- Department of Medical Oncology, Public Hospital Rouiba Larbi Abdelsalem Street, 16000 Algiers, Algeria
| | - Zohra Mechiat
- Department of Medical Oncology, Public Hospital Rouiba Larbi Abdelsalem Street, 16000 Algiers, Algeria
| | - Yamina Maachou
- Department of Medical Oncology, Public Hospital Rouiba Larbi Abdelsalem Street, 16000 Algiers, Algeria
| | - Souad Souilah
- Department of Pneumology, Center University of Bab el Oued, Said Taouti Boulevard, 16000 Algiers, Algeria
| | - Malika Gamaz
- Department of Medical Oncology, Center Pierre Marie Curie, 1stMay place 1945, 16000 Algiers, Algeria
| | - Faiza Reguig
- Department of Medical Oncology, Cancer Center of Sidi Bel Abbas, Boulevard de Hospital, 22000 Sidi Bel Abbas, Algeria
| | - Sarah Tabouri
- Department of Medical Oncology, Cancer Center of Sidi Bel Abbas, Boulevard de Hospital, 22000 Sidi Bel Abbas, Algeria
| | - Meriem Bouannika
- Department of Medical Oncology, Cancer Center of Sidi Bel Abbas, Boulevard de Hospital, 22000 Sidi Bel Abbas, Algeria
| | - Soumeya Ghomari
- Department of Medical Oncology, Center University of Tlemcen, 05 Bd Mohammed V, 13000 Tlemcen, Algeria
| | - Amina Rostane
- Department of Medical Oncology, Center University of Tlemcen, 05 Bd Mohammed V, 13000 Tlemcen, Algeria
| | - Wassila Ougdi
- Department of Medical Oncology, Center University of Tlemcen, 05 Bd Mohammed V, 13000 Tlemcen, Algeria
| | - Lamia Belbachir
- Department of Medical Oncology, Center University of Tlemcen, 05 Bd Mohammed V, 13000 Tlemcen, Algeria
| | - Abdelkader Bousahba
- Department of Medical Oncology, Center University of Oran, Boulevard Docteur Benzerdjeb, Plateau, 31000 Oran, Algeria
| | - Fatima Seghier
- Department of Medical Oncology, Center University of Oran, Boulevard Docteur Benzerdjeb, Plateau, 31000 Oran, Algeria
| | - Ahlam Megaiz
- Department of Medical Oncology, Center University of Oran, Boulevard Docteur Benzerdjeb, Plateau, 31000 Oran, Algeria
| | - Amine Mesli Mohamed
- Department of Medical Oncology, Center University of Oran, Boulevard Docteur Benzerdjeb, Plateau, 31000 Oran, Algeria
| | - Merzak Gharnaout
- Department of Pneumology, Public Hospital Rouiba Larbi Abdelsalem Street, 16000 Algiers, Algeria
| | - Djidjelia Ihadadenne
- Department of Pneumology, Public Hospital Rouiba Larbi Abdelsalem Street, 16000 Algiers, Algeria
| | - Assia Bensalem
- Department of Medical Oncology, Public Hospital Didouche Mourad, Ain El Bir Didouche Mourad, 25000 Constantine, Algeria
| | - Samah Namous Anissa
- Department of Medical Oncology, Public Hospital Didouche Mourad, Ain El Bir Didouche Mourad, 25000 Constantine, Algeria
| | - Sabrina Djeghim
- Department of Medical Oncology, Public Hospital Didouche Mourad, Ain El Bir Didouche Mourad, 25000 Constantine, Algeria
| | - Sofiane Khelifi Touhami
- Department of Medical Oncology, Public Hospital Didouche Mourad, Ain El Bir Didouche Mourad, 25000 Constantine, Algeria
| | - Kamel Bouzid
- Department of Medical Oncology, Center Pierre Marie Curie, 1stMay place 1945, 16000 Algiers, Algeria
| | - Esma Kerboua
- Department of Medical Oncology, Center Pierre Marie Curie, 1stMay place 1945, 16000 Algiers, Algeria
| | - Mohammed Oukkal
- Department of Medical Oncology, Center University Beni Messous, Ibrahim Hadjeras Street, 16206 Beni Messous, Algeria
| | - Farida Hadjam
- Department of Medical Oncology, Center University Beni Messous, Ibrahim Hadjeras Street, 16206 Beni Messous, Algeria
| | - Farida Smaili
- University of Blida 1, Faculty of Medicine, BP 270, Route de soumaa, Blida, Algeria
| | - Sana Bekkouche
- University of Blida 1, Faculty of Medicine, BP 270, Route de soumaa, Blida, Algeria
| | - Noureddine Zidouni
- Department of Pneumo-physiology, Center University of Beni Messous, Ibrahim Hadjeras Street, 16206 Beni Messous, Algeria
| | - Dalila Mekideche
- Department of Pneumo-physiology, Center University of Beni Messous, Ibrahim Hadjeras Street, 16206 Beni Messous, Algeria
| | - Amina Mebrek
- Department of Pneumo-physiology, Center University of Beni Messous, Ibrahim Hadjeras Street, 16206 Beni Messous, Algeria
| | - Habib Douagui
- Department of Pneumo-allergology, Center University of Beni Messous, 16206 Beni Messous, Algeria
| | - Rachid Abdelaziz
- Department of Pneumo-allergology, Center University of Beni Messous, 16206 Beni Messous, Algeria
| | - Mohamed Lemdani
- Department of Pneumo-allergology, Center University of Beni Messous, 16206 Beni Messous, Algeria
| | - Ghania Malki
- Department of Pneumo-allergology, Center University of Beni Messous, 16206 Beni Messous, Algeria
| | - Aziza Fissah
- Department of Pneumology, Center University of Bab el Oued, Said Taouti Boulevard, 16000 Algiers, Algeria
| | - Blaha Larbaoui
- Department of Medical Oncology, Cancer Center of Oran Messerghine, 31031 Oran, Algeria
| | - Nawel Sadji
- Department of Medical Oncology, Cancer Center of Oran Messerghine, 31031 Oran, Algeria
| | - Sarra Zeroual
- Department of Medical Oncology, Cancer Center of Oran Messerghine, 31031 Oran, Algeria
| | - Taha Filali
- Department of Medical Oncology, Center University of Constantine, Cheikh Benbadis Street, 25000 Constantine, Algeria
| | - Lamia Ayadi
- Department of Medical Oncology, Center University of Constantine, Cheikh Benbadis Street, 25000 Constantine, Algeria
| | - Lilia Youcef Ali
- Department of Medical Oncology, Center University of Constantine, Cheikh Benbadis Street, 25000 Constantine, Algeria
| | - Abdelmadjid Djebbar
- Department of Pneumology, Public Hospital of Batna, Tazoult Street, 05000 Batna, Algeria
| | - Radia Heddane
- Department of Pneumology, Public Hospital of Batna, Tazoult Street, 05000 Batna, Algeria
| | - Bahrsia Haddad
- Department of Pneumology, Public Hospital of Batna, Tazoult Street, 05000 Batna, Algeria
| | - Hanene Djedi
- Department of Medical Oncology, Cancer Center of Annaba, Hospital Street, 23000 Annaba, Algeria
| | - Asma Yousfi
- Department of Medical Oncology, Cancer Center of Annaba, Hospital Street, 23000 Annaba, Algeria
| | - Lamia Debbah
- Department of Medical Oncology, Cancer Center of Annaba, Hospital Street, 23000 Annaba, Algeria
| | - Kada Boualga
- Department of Radiotherapy, Cancer Center of Blida, 02 Zabana Street, 09018 Blida, Algeria
| | - Ladj Ouali
- Department of Radiotherapy, Cancer Center of Blida, 02 Zabana Street, 09018 Blida, Algeria
| | - Zohra Guettaf Fatima
- Department of Radiotherapy, Cancer Center of Blida, 02 Zabana Street, 09018 Blida, Algeria
| | - Assia Moussei
- Department of Medical Oncology, Public Hospital of Sidi Ghiles Tipaza, 42000 Tipaza, Algeria
| | - Mourad Houri
- Department of Medical Oncology, Public Hospital of Sidi Ghiles Tipaza, 42000 Tipaza, Algeria
| | - Amal Haddouche
- AstraZeneca Algeria, Micro-business Park N°20-Bloc A, 6th Floor - Doudou Mokhtar Street, Hydra, 16035 Algiers, Algeria
| | - Meriem Kedar
- AstraZeneca Algeria, Micro-business Park N°20-Bloc A, 6th Floor - Doudou Mokhtar Street, Hydra, 16035 Algiers, Algeria
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Priehodová E, Austerlitz F, Čížková M, Nováčková J, Ricaut FX, Hofmanová Z, Schlebusch CM, Černý V. Sahelian pastoralism from the perspective of variants associated with lactase persistence. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 173:423-436. [PMID: 32812238 DOI: 10.1002/ajpa.24116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/17/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Archeological evidence shows that first nomadic pastoralists came to the African Sahel from northeastern Sahara, where milking is reported by ~7.5 ka. A second wave of pastoralists arrived with the expansion of Arabic tribes in 7th-14th century CE. All Sahelian pastoralists depend on milk production but genetic diversity underlying their lactase persistence (LP) is poorly understood. MATERIALS AND METHODS We investigated SNP variants associated with LP in 1,241 individuals from 29 mostly pastoralist populations in the Sahel. Then, we analyzed six SNPs in the neighboring fragment (419 kb) in the Fulani and Tuareg with the -13910*T mutation, reconstructed haplotypes, and calculated expansion age and growth rate of this variant. RESULTS Our results reveal a geographic localization of two different LP variants in the Sahel: -13910*T west of Lake Chad (Fulani and Tuareg pastoralists) and -13915*G east of there (mostly Arabic-speaking pastoralists). We show that -13910*T has a more diversified haplotype background among the Fulani than among the Tuareg and that the age estimate for expansion of this variant among the Fulani (~8.5 ka) corresponds to introduction of cattle to the area. CONCLUSIONS This is the first study showing that the "Eurasian" LP allele -13910*T is widespread both in northern Europe and in the Sahel; however, it is limited to pastoralists in the Sahel. Since the Fulani haplotype with -13910*T is shared with contemporary Eurasians, its origin could be in a region encompassing the Near East and northeastern Africa in a population ancestral to both Saharan pastoralists and European farmers.
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Affiliation(s)
- Edita Priehodová
- Archaeogenetics Laboratory, Institute of Archaeology of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Frédéric Austerlitz
- UMR 7206 EcoAnthropologie et Ethnobiologie, CNRS/MNHN/Université Paris Diderot, Musée de l'Homme, Paris, France
| | - Martina Čížková
- Archaeogenetics Laboratory, Institute of Archaeology of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Jana Nováčková
- Archaeogenetics Laboratory, Institute of Archaeology of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - François-Xavier Ricaut
- Department of Evolution and Biological Diversity (UMR 5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, Toulouse, France
| | - Zuzana Hofmanová
- Archaeogenetics Laboratory, Institute of Archaeology of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Carina M Schlebusch
- Department of Organismal Biology, Evolutionary Biology Centre, Uppsala University, Uppsala, Sweden.,Palaeo-Research Institute, University of Johannesburg, Auckland Park, South Africa.,SciLifeLab, Uppsala, Sweden
| | - Viktor Černý
- Archaeogenetics Laboratory, Institute of Archaeology of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
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Hughes EC, Anderson NE. Zoonotic Pathogens of Dromedary Camels in Kenya: A Systematised Review. Vet Sci 2020; 7:vetsci7030103. [PMID: 32764264 PMCID: PMC7559378 DOI: 10.3390/vetsci7030103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/21/2020] [Accepted: 07/01/2020] [Indexed: 01/26/2023] Open
Abstract
Kenya is home to Africa’s third largest population of dromedary camels, and production at commercial and local levels are increasingly important. In pastoral and nomadic communities in the arid and semi-arid lands (ASALs), camels play a vital role in food security, while commercial milk production and formalized export markets are rapidly emerging as camel populations expand into non-traditional areas. Until recently, little focus was placed on camels as hosts of zoonotic disease, but the emergence of Middle Eastern respiratory coronavirus (MERS-CoV) in 2012, and the discovery of exposure to the virus in Kenyan camels, highlighted the need for further understanding of this area. This systematised review utilised a robust search strategy to assess the occurrence of camel-associated zoonoses in Kenya and to evaluate the quality of the published literature. Seventy-four studies were identified, covering sixteen pathogens, with an increasing number of good quality studies in recent years. Despite this, the area remains under-researched and there is a lack of robust, high-quality research. Trypanosome spp., Echinococcus granulosus and Brucella spp. appeared most frequently in the literature. Pathogens with the highest reported prevalence were MERS-CoV (0–100%), Echinococcus granulosa (7–60%) and Rift Valley fever virus (7–57%). Exposure to Brucella spp., Coxiella burnetii and Crimean-Congo haemorrhagic fever virus showed higher levels in camel or camel-associated vectors than other livestock species, although brucellosis was the only disease for which there was robust evidence linking camel and human exposure. Zoonotic agents with less severe human health outcomes, such as Dermatophilosus congolensis and contagious ecthyma, were also represented in the literature. This review provides an important summary of the scope and quality of current knowledge. It demonstrates that further research, and improved adherence to robust study design and reporting are essential if the zoonotic risk from camels in Kenya, and elsewhere, is to be better understood.
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Affiliation(s)
- Ellen Clare Hughes
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Roslin EH25 9RG, UK;
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Henry Wellcome Building, Garscube Campus, Glasgow G61 1QH, UK
- Correspondence:
| | - Neil Euan Anderson
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Roslin EH25 9RG, UK;
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Health services uptake among nomadic pastoralist populations in Africa: A systematic review of the literature. PLoS Negl Trop Dis 2020; 14:e0008474. [PMID: 32716938 PMCID: PMC7447058 DOI: 10.1371/journal.pntd.0008474] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 08/25/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022] Open
Abstract
The estimated 50 million nomadic pastoralists in Africa are among the most "hard-to-reach" populations for health-service delivery. While data are limited, some studies have identified these communities as potential disease reservoirs relevant to neglected tropical disease programs, particularly those slated for elimination and eradication. Although previous literature has emphasized the role of these populations' mobility, the full range of factors influencing health service utilization has not been examined systematically. We systematically reviewed empirical literature on health services uptake among African nomadic pastoralists from seven online journal databases. Papers meeting inclusion criteria were reviewed using STROBE- and PRISMA-derived guidelines. Study characteristics were summarized quantitatively, and 10 key themes were identified through inductive qualitative coding. One-hundred two papers published between 1974-2019 presenting data from 16 African countries met our inclusion criteria. Among the indicators of study-reporting quality, limitations (37%) and data analysis were most frequently omitted (18%). We identified supply- and demand-side influences on health services uptake that related to geographic access (79%); service quality (90%); disease-specific knowledge and awareness of health services (59%); patient costs (35%); contextual tailoring of interventions (75%); social structure and gender (50%); subjects' beliefs, behaviors, and attitudes (43%); political will (14%); social, political, and armed conflict (30%); and community agency (10%). A range of context-specific factors beyond distance to facilities or population mobility affects health service uptake. Approaches tailored to the nomadic pastoralist lifeway, e.g., that integrated human and veterinary health service delivery (a.k.a., "One Health") and initiatives that engaged communities in program design to address social structures were especially promising. Better causal theorization, transdisciplinary and participatory research methods, clearer operational definitions and improved measurement of nomadic pastoralism, and key factors influencing uptake, will improve our understanding of how to increase accessibility, acceptability, quality and equity of health services to nomadic pastoralist populations.
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29
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Njisane YZ, Mukumbo FE, Muchenje V. An outlook on livestock welfare conditions in African communities - A review. ASIAN-AUSTRALASIAN JOURNAL OF ANIMAL SCIENCES 2020; 33:867-878. [PMID: 31480203 PMCID: PMC7206380 DOI: 10.5713/ajas.19.0282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/13/2019] [Accepted: 05/29/2019] [Indexed: 11/27/2022]
Abstract
A significant proportion of the African continent is conducive for animal agricultural production, due to its historical experience and available resources to accommodate and nurture various indigenous and exotic animal species and breeds. With food security being a global challenge, animal products can play an important role as nutrient dense food sources in human diets, particularly in Africa. However, this does not seem to reach its full potential in practice, due to numerous reasons that have not been adequately addressed. Animal welfare reservations can be highlighted as one of the major contributing factors to the curbed progress. The consequences have been scientifically proven to affect product quality and market access. However, in the African community, the concept of animal welfare has not been fully embraced. While there are international animal welfare standards in the developed world, there are inherent factors that hinder adoption of such initiatives in most developing regions, particularly among communal farmers. These include cultural norms and practices, social ranking, socio-economic status, available resources, information dissemination and monitoring tools. Therefore, there is need to harmonize what is internationally required and what is feasible to accommodate global variability. The protocols followed to ensure and evaluate farm animal welfare require regular investigation, innovation and a sustainable approach to enhance animal productivity, efficiency and product quality. Additionally, investing in animal wellbeing and health, as well as empowering communities with significant knowledge, has a potential to improve African livelihoods and contribute to food security. This review seeks to highlight the concept of animal welfare in relation to livestock and food production in African conditions.
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Affiliation(s)
- Yonela Zifikile Njisane
- Department of Livestock and Pasture Science, University of Fort Hare, P. Bag X1314, Alice 5700,
South Africa
- Risk and Vulnerability Research Centre, University of Fort Hare, P. Bag X1314, Alice 5700,
South Africa
| | - Felicitas Esnart Mukumbo
- Department of Livestock and Pasture Science, University of Fort Hare, P. Bag X1314, Alice 5700,
South Africa
| | - Voster Muchenje
- Department of Livestock and Pasture Science, University of Fort Hare, P. Bag X1314, Alice 5700,
South Africa
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30
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Ali M, Cordero JP, Khan F, Folz R. 'Leaving no one behind': a scoping review on the provision of sexual and reproductive health care to nomadic populations. BMC WOMENS HEALTH 2019; 19:161. [PMID: 31842838 PMCID: PMC6916058 DOI: 10.1186/s12905-019-0849-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/14/2019] [Indexed: 11/10/2022]
Abstract
BACKGRUND Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. METHODS Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. RESULTS Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. CONCLUSION Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.
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Affiliation(s)
- Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland.
| | - Joanna Paula Cordero
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland
| | - Faria Khan
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland
| | - Rachel Folz
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland
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31
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Umer A, Zinsstag J, Schelling E, Tschopp R, Hattendof J, Osman K, Yuya M, Ame A, Zemp E. Antenatal care and skilled delivery service utilisation in Somali pastoral communities of Eastern Ethiopia. Trop Med Int Health 2019; 25:328-337. [PMID: 31733130 PMCID: PMC7079025 DOI: 10.1111/tmi.13346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To assess maternal health care service utilisation and associated factors in Somali pastoral communities of eastern Ethiopia. Methods Community‐based cross‐sectional study complemented by qualitative assessments in Adadle district, Somali region, eastern Ethiopia, among 450 women in six kebeles from August to September 2016. Logistic regression was used to assess factors associated with antenatal care use and skilled delivery care use, controlling for confounders. Results About 27% [95%CI 22.8–31.2%] of women used antenatal care, and 22.6% [95%CI 18.7–26.5%] received skilled delivery service. None of the respondents reported post‐natal care. About 43% reported that they had no knowledge of antenatal care, and 46% did not perceive delivery at a health facility as important. Pastoral lifestyle, husband’s educational status, women’s attitude towards health care service and financial support from the husband were significantly associated with antenatal care utilisation. Health professionals’ attitudes, perceptions of institutional delivery, antenatal care utilisation and information about exemptions from maternal health care fees were associated with skilled delivery service utilisation. Conclusion Improving community awareness of antenatal care, employing female health professionals and culturally adapted guidelines could improve skilled delivery utilisation. In a patriarchal society, involving male partners in all maternal health issues is essential to increase use of maternal health services and to decrease maternal mortality.
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Affiliation(s)
- A Umer
- Jigjiga University, Jigjiga, Ethiopia.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - J Zinsstag
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - E Schelling
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - R Tschopp
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - J Hattendof
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - K Osman
- Jigjiga University, Jigjiga, Ethiopia.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - M Yuya
- Jigjiga University, Jigjiga, Ethiopia
| | - A Ame
- Dire Dawa University, Dire Dawa, Ethiopia
| | - E Zemp
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Afolayan AO, Ayeni FA, Moissl-Eichinger C, Gorkiewicz G, Halwachs B, Högenauer C. Impact of a Nomadic Pastoral Lifestyle on the Gut Microbiome in the Fulani Living in Nigeria. Front Microbiol 2019; 10:2138. [PMID: 31572342 PMCID: PMC6753190 DOI: 10.3389/fmicb.2019.02138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/30/2019] [Indexed: 12/23/2022] Open
Abstract
The co-evolution of the gut microbiota with its human host has revolutionized our current scientific viewpoint about the contribution of diet and lifestyle on human health. Most studies so far have focused on populations living in the United States and Europe or compared those with communities from other geographic areas in the world. In order to determine the taxonomic and predicted functional profile of the gut microbiome of a hitherto unstudied human community, we investigated the phylogenetic diversity of the gut microbiota in a community of Fulani nomadic pastoralists, and their semi-urbanized neighbors - the Jarawa. The Jarawa reside in a city (Jos) in the north-central part of Nigeria, and are adapted in part to a westernized lifestyle. The nomadic Fulani lifestyle resembles a mix of Paleolithic and Neolithic lifestyle patterns with a greater predisposition to diseases. The fecal microbiota of the Fulani and the Jarawa were characterized by paired-end Illumina MiSeq sequencing of the 16S rRNA gene, followed by downstream bioinformatics analysis of the sequence reads. The Fulani harbored increased numbers of signatures of microbes that are known to be associated with a foraging lifestyle such as the Bacteroidetes, Spirochaetes, and Prevotellaceae, while the Jarawa were dominated by signatures of Firmicutes, Ruminococcaceae, Lachnospiraceae, and Christensenellaceae. Notably, the gut microbiota of the Fulani showed less taxonomic diversity than those of the Jarawa. Although they reside in the same geographical zone, microbial community composition was significantly different between the two groups. Pathogens were predicted to be more abundant in the gut microbiota of the Fulani than of the Jarawa. Predicted pathogenic pathways and pathways associated with the breakdown of fiber-rich diet were enriched in the Fulani, including glutathione metabolism, while pathways associated with the consumption of low-fiber diet and xenobiotics, including fructose and mannose metabolic pathways, and nitrotoluene degradation pathways, respectively, were enriched in the Jarawa. Significant differences in composition between both groups were likely due to differences in diet and lifestyle and exposure to pathogens. These results suggest that microbial diversity may not always be higher in non-industrialized societies than in westernized societies, as previously assumed.
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Affiliation(s)
- Ayorinde O. Afolayan
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Funmilola A. Ayeni
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Christine Moissl-Eichinger
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Interuniversity Cooperation, Graz, Austria
| | - Gregor Gorkiewicz
- BioTechMed, Interuniversity Cooperation, Graz, Austria
- Institute of Pathology, Medical University of Graz, Graz, Austria
- Theodor Escherich Laboratory for Microbiome Research, Graz, Austria
| | - Bettina Halwachs
- BioTechMed, Interuniversity Cooperation, Graz, Austria
- Institute of Pathology, Medical University of Graz, Graz, Austria
- Theodor Escherich Laboratory for Microbiome Research, Graz, Austria
| | - Christoph Högenauer
- Institute of Pathology, Medical University of Graz, Graz, Austria
- Theodor Escherich Laboratory for Microbiome Research, Graz, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Wild H, Glowacki L, Maples S, Mejía-Guevara I, Krystosik A, Bonds MH, Hiruy A, LaBeaud AD, Barry M. Making Pastoralists Count: Geospatial Methods for the Health Surveillance of Nomadic Populations. Am J Trop Med Hyg 2019; 101:661-669. [PMID: 31436151 PMCID: PMC6726942 DOI: 10.4269/ajtmh.18-1009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/18/2019] [Indexed: 11/07/2022] Open
Abstract
Nomadic pastoralists are among the world's hardest-to-reach and least served populations. Pastoralist communities are difficult to capture in household surveys because of factors including their high degree of mobility over remote terrain, fluid domestic arrangements, and cultural barriers. Most surveys use census-based sampling frames which do not accurately capture the demographic and health parameters of nomadic populations. As a result, pastoralists are "invisible" in population data such as the Demographic and Health Surveys (DHS). By combining remote sensing and geospatial analysis, we developed a sampling strategy designed to capture the current distribution of nomadic populations. We then implemented this sampling frame to survey a population of mobile pastoralists in southwest Ethiopia, focusing on maternal and child health (MCH) indicators. Using standardized instruments from DHS questionnaires, we draw comparisons with regional and national data finding disparities with DHS data in core MCH indicators, including vaccination coverage, skilled birth attendance, and nutritional status. Our field validation demonstrates that this method is a logistically feasible alternative to conventional sampling frames and may be used at the population level. Geospatial sampling methods provide cost-affordable and logistically feasible strategies for sampling mobile populations, a crucial first step toward reaching these groups with health services.
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Affiliation(s)
- Hannah Wild
- Stanford University School of Medicine, Stanford, California
| | - Luke Glowacki
- Department of Anthropology, Pennsylvania State University
| | - Stace Maples
- Stanford Geospatial Center, Stanford University, Stanford, California
| | - Iván Mejía-Guevara
- Department of Biology, Stanford University, Stanford, California
- Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California
| | - Amy Krystosik
- Division of Infectious Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Abiy Hiruy
- Pathfinder International, Addis Ababa, Ethiopia
| | - A. Desiree LaBeaud
- Division of Infectious Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Michele Barry
- The Center for Innovation in Global Health, Stanford University, Stanford, California
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Sima BT, Belachew T, Bjune G, Abebe F. Traditional healers' role in the detection of active tuberculosis cases in a pastoralist community in Ethiopia: a pilot interventional study. BMC Public Health 2019; 19:721. [PMID: 31182067 PMCID: PMC6558710 DOI: 10.1186/s12889-019-7074-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Pastoralists rely on traditional healers (THs) for general health problems. However, some studies indicate that such practices result in delays in the diagnosis and treatment of tuberculosis (TB) cases. This study aims to assess the role of traditional healers in the detection and referral of active TB cases in a pastoralist community. Methods We identified 22 traditional healers from 7 villages of Kereyu pastoralist community in the Fentale district in Ethiopia in January 2015. We trained these THs in identifying presumptive TB symptoms and early referral to the nearby healthcare facilities. The training was held during a 1 week period that included a visit to their villages and follow-up. A 1 day meeting was held with the traditional healers, the district TB care and prevention coordinator and health extension workers from the selected sub-district to discuss the referral link between THs and the nearby healthcare facilities. Health providers working at the TB units in the selected healthcare facilities were oriented about the training given and planned involvement of THs in referring presumptive TB case. In addition, documentation of the presumptive TB cases was discussed. Results We succeeded in tracing and interviewing 8 of the 22 THs. The rest were on seasonal migration. According to the THs report for the 1 year period, these 8 THs had referred 24 TB suspects to the healthcare facilities. Sputum smear microscopy confirmed 13 of the 24 suspects as having TB cases. Among those confirmed, 10 completed treatment and three were on treatment. Five presumptive TB cases were confirmed non TB cases through further evaluation at the healthcare facilities and six of the presumptive TB cases were lost to follow up by the THs. Whereas, four of the presumptive TB cases were lost to follow up to the healthcare facility. Conclusions Results of the present study indicate that THs can contribute to the detection of undiagnosed active TB cases in a pastoralist community, provided they are given appropriate training and support. Electronic supplementary material The online version of this article (10.1186/s12889-019-7074-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bezawit Temesgen Sima
- Department of Health Education and Behavioural Science, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia. .,Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway. .,, Oslo, Norway.
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health Science, Jimma University, P.O.Box 378, Jimma, Ethiopia
| | - Gunnar Bjune
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway
| | - Fekadu Abebe
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway
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Sima BT, Belachew T, Abebe F. Health care providers' knowledge, attitude and perceived stigma regarding tuberculosis in a pastoralist community in Ethiopia: a cross-sectional study. BMC Health Serv Res 2019; 19:19. [PMID: 30621678 PMCID: PMC6325851 DOI: 10.1186/s12913-018-3815-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) remains the prime killer disease among infectious diseases. TB control depends on early case detection and treatment in a directly observed treatment short course (DOTS) programme. The success of DOTS depends on the ability of the health care system to identify and properly manage TB cases. The present study aims to assess healthcare provider (HCP) knowledge, attitude and perceived stigma regarding TB and perception about traditional healers. Methods A descriptive cross sectional study was conducted among 108 HCPs using a semi-structured, self-administered questionnaire from September 2014 to January 2015. The study district has a high TB burden area with one district hospital, 4 health centres, and 18 health posts. All health facilities and HCPs available during the study period in the district were included in the study. Statistical software for social science (SPSS) version 22 and STATA version 14 were used to enter and analyse data, respectively. Results The majority (64%) of the HCPs had poor overall knowledge regarding TB, and 67.6 and 57.6% had poor knowledge regarding TB diagnosis and nature of the disease, respectively. Moreover, most 66.7 and 55.6% of the HCPs had an unfavourable attitude towards TB and TB control systems, respectively. Slightly under half (49.1%) of the HCPs had a favourable attitude towards TB patients, and the majority (88.9%) had low perceived stigma. The majority (87.0%) of the HCPs indicated the importance of community involvement in TB control activity. Moreover, most (60.2%) of the HCPs showed willingness to collaborate with traditional healers (THs) on TB control activity. Conclusions Healthcare workers’ knowledge gap and unfavourable attitude towards TB control systems reported in this study may cause poor TB care delivery. HCPs’ perception of the importance of community involvement in TB control and willingness to collaborate with THs on TB management could be an opportunity to strengthen the World Health Organization’s (WHO’s) component of End TB strategy through community engagement. Training and workshops could be used to address the knowledge gap and the unfavourable attitude regarding TB among HCPs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3815-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bezawit Temesgen Sima
- Department of Health Education and Behavioral Science, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia. .,Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway.
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health Science, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Fekadu Abebe
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway
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Moucheraud C, Gyal L, Gyaltsen K, Tsering L, Narasimhan S, Gipson J. Maternal Health Behaviors and Outcomes in a Nomadic Tibetan Population. Matern Child Health J 2019; 22:264-273. [PMID: 29124625 DOI: 10.1007/s10995-017-2398-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction Despite significant global improvements in maternal health, large disparities persist. In China, rural women and women who live in western regions experience lower rates of maternal healthcare utilization and higher rates of maternal mortality than women elsewhere in the country. This paper examines maternal health care-seeking among nomadic Tibetan women in rural western China, a particularly understudied group. Methods Secondary data analysis was conducted with survey data collected in 2014 in Qinghai Province, China. Participants (rural, nomadic, adult women) provided birth histories and information on care received during antenatal, intrapartum and/or postpartum period(s). Using bivariate and multivariable logistic regression models, these outcomes were explored in relation to maternal characteristics (e.g., educational attainment and parity), use of health insurance, and time. Results Approximately half of all women had ever used antenatal care, institutional delivery, and/or skilled birth attendance. The utilization of these services has increased over time, from 10% of births prior to the year 2000, to approximately 50% since 2000. Utilization increased by year (odds ratios ranging from 1.1 to 1.3) even after controlling for covariates. Women with health insurance coverage were significantly more likely to use these services than women without insurance, although less than 20% of women reported that insurance paid for any antenatal and/or childbirth care. Discussion Utilization of maternal care is improving among this population but rates remain low in comparison to other women in rural, western China. Further targeted interventions may be needed to reach and adequately address the maternal health needs of this unique population.
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Affiliation(s)
- Corrina Moucheraud
- University of California Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA.
| | - Lhusham Gyal
- Tso-Ngon (Qinghai) University Tibetan Medical College, No. 16 Kunlun Road Rd., Xining, 810001, Qinghai, People's Republic of China
| | - Kunchok Gyaltsen
- Tso-Ngon (Qinghai) University Tibetan Medical College, No. 16 Kunlun Road Rd., Xining, 810001, Qinghai, People's Republic of China
| | - Lumo Tsering
- Tso-Ngon (Qinghai) University Tibetan Medical College, No. 16 Kunlun Road Rd., Xining, 810001, Qinghai, People's Republic of China
| | - Subasri Narasimhan
- University of California Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
| | - Jessica Gipson
- University of California Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
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Bawa S, Afolabi M, Abdelrahim K, Abba G, Ningi A, Tafida SY, Tegegne SG, Warigon C, Nomhwange T, Umar SA, Aregay A, Fanti A, Ahmed B, Nsubuga P, Adamu U, Braka F, Wondimagegnehu A, Shuaib F. Transboundary nomadic population movement: a potential for import-export of poliovirus. BMC Public Health 2018; 18:1316. [PMID: 30541502 PMCID: PMC6292162 DOI: 10.1186/s12889-018-6190-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Nomadic populations have a considerably higher risk of contracting a number of diseases but, despite the magnitude of the public health risks involved, they are mostly underserved with few health policies or plans to target them. Nomadic population movements are shown to be a niche for the transmission of diseases, including poliomyelitis. The nomadic routes traverse the northern states of Nigeria to other countries in the Lake Chad subregion. As part of the February 2016 polio supplemental immunization activity (SIA) plans in Bauchi state, a review of nomadic routes and populations identified a nomadic population who originated from outside the international borders of Nigeria. This study describes the engagement process for a transboundary nomadic population and the interventions provided to improve population immunity among them while traversing through Nigeria. Methods This was an intervention study which involved a cross-sectional mixed-method (quantitative and qualitative) survey. Information was collected on the nomadic pastoralists entry and exit points, resting points, and health-seeking behavior using key informant interviews and semistructured questionnaire. Transit vaccination teams targeted the groups with oral polio vaccines (OPVs) and other routine antigens along identified routes during the months of February to April 2016. Mobile health teams provided immunization and other child and maternal health survival interventions. Results A total of 2015 children aged under 5 years were vaccinated with OPV, of which 264 (13.1%) were zero-dose during the February 2016 SIAs while, in the March immunization plus days (IPDs), 1864 were immunized of which 211 (11.0%) were zero-dose. A total of 296 children aged under 1 year old were given the first dose of pentavalent vaccine (penta 1), while 119 received the third dose (penta 3), giving a dropout rate of 59.8%. Conclusions Nomadic pastoralists move across international borders and there is a need for transboundary policies among the countries in the Lake Chad region to improve population immunity and disease surveillance through a holistic approach using the One-health concept.
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Affiliation(s)
- Samuel Bawa
- World Health Organization, Country Representative Office, Abuja, Nigeria.
| | | | | | - Goni Abba
- World Health Organization, Bauchi State Office, Bauchi, Nigeria
| | - Adamu Ningi
- World Health Organization, Bauchi State Office, Bauchi, Nigeria
| | | | - Sisay G Tegegne
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Charity Warigon
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Terna Nomhwange
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Aron Aregay
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Ahmed Fanti
- Bauchi state Primary Health Care Development Agency, Bauchi, Nigeria
| | - Bakoji Ahmed
- Bauchi state Primary Health Care Development Agency, Bauchi, Nigeria
| | | | - Usman Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fiona Braka
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Armah FA, Amponsah IK, Mensah AY, Dickson RA, Steenkamp PA, Madala NE, Adokoh CK. Leishmanicidal activity of the root bark of Erythrophleum Ivorense (Fabaceae) and identification of some of its compounds by ultra-performance liquid chromatography quadrupole time of flight mass spectrometry (UPLC-QTOF-MS/MS). JOURNAL OF ETHNOPHARMACOLOGY 2018; 211:207-216. [PMID: 28970156 DOI: 10.1016/j.jep.2017.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/07/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Leishmaniasis is one of the neglected tropical disease caused by a protozoan of the genus Leishmania transmitted by sandflies. High cost and lack of oral formulation of existing drugs, rapid developments of resistance by the parasite coupled with serious side effects require new treatments to augment or replace currently available therapies. The major merits of herbal medicine seem to demonstrate perceived efficacy, low incidence of serious adverse effects and low cost. Erythrophleum plants possess beneficial biological properties and, as such, characterization of the bioactive components of these plants is imperative. Previous work has shown an overwhelming presence of cassaine alkaloids in these plants. However, amongst these plants, the African based specie (Erythrophleum ivorense) is the least studied. OBJECTIVE In the current study, the in vitro anti-leishmanial activity of the crude extract, its fractions and isolated compounds were evaluated using direct counting assay of promastigotes of Leishmania donovani using amphotericin B as positive control. MATERIALS AND METHODS The anti-leishmanial activity of E. ivorense extract was evaluated in vitro against the promastigote forms of Leishmania Donovani using a direct counting assay based on growth inhibition. Different crude extracts from ethyl acetate, pet-ether, and methanol as well as pure isolated compounds of E. ivorense: Erythroivorensin, Eriodictyol and Betulinic acid were screened. To know the possible components of the active methanolic extract, attempt was made to elucidate the extract using ultra-performance liquid chromatography quadrupole time of flight mass spectrometry (UHPLC-QTOF-MS/MS). RESULTS This afforded a weak pet-ether fraction, a moderately active ethyl acetate fraction and a significantly active methanol fraction (IC50 = 2.97μg/mL) compared to Amphotericin B (IC50 = 2.40±0.67μg/mL). The novel diterpene erythroivorensin, betulinic acid and the flavanone Eriodictyol, from the ethyl acetate fraction, showed weak activity. UPLC-QTOF-MS/MS was used to identify the cassaine diterpenoids from the active methanol fraction. Here, 10 compounds of this type were putatively identified from the ethanol crude extract. CONCLUSION The fragmentation mechanism of these metabolites is also proposed and are expected to serve as reference template for identification of these and related compounds in future. The presence of these compounds is an indication that they are an inherited and evolutionary component of plants belonging to the Erythrophleum genus. Our results further present another dimension where these compounds and their relative abundances can be used as chemo-taxonomical bio-markers of the genus. The present study also successfully demonstrated/re-affirmed the use of UPLC-QTOF-MS/MS as a robust technique for the characterization of natural products.
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Affiliation(s)
- Francis A Armah
- Department of Biomedical Sciences, Faculty of Allied Sciences, College of Health and Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Isaac K Amponsah
- Department of Pharmacognosy, Faculty of Pharmacy & Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Abraham Y Mensah
- Department of Pharmacognosy, Faculty of Pharmacy & Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Rita A Dickson
- Department of Pharmacognosy, Faculty of Pharmacy & Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Paul A Steenkamp
- Council for Scientific and Industrial Research (CSIR), Biosciences, Natural Products and Agroprocessing Group, Pretoria 0001, South Africa; Department of Biochemistry, University of Johannesburg, P.O. Box 524, Auckland Park 2006, South Africa
| | - Ntakadzeni E Madala
- Department of Biochemistry, University of Johannesburg, P.O. Box 524, Auckland Park 2006, South Africa
| | - Christian K Adokoh
- Department of Forensic Sciences, School of Biological Sciences, University of Cape Coast, Cape Coast, Ghana.
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Greter H, Cowan N, Ngandolo BN, Kessely H, Alfaroukh IO, Utzinger J, Keiser J, Zinsstag J. Treatment of human and livestock helminth infections in a mobile pastoralist setting at Lake Chad: Attitudes to health and analysis of active pharmaceutical ingredients of locally available anthelminthic drugs. Acta Trop 2017; 175:91-99. [PMID: 27235793 DOI: 10.1016/j.actatropica.2016.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 12/31/2022]
Abstract
Mobile pastoralists face challenges in accessing quality health care and medication for managing human and animal diseases. We determined livestock disease priorities, health seeking behaviour of people bearing helminthiases and - placing particular emphasis on trematode infections - treatment strategies and outcome satisfaction among mobile pastoralists of four ethnic groups in the Lake Chad area using focus group discussions. People suffering from schistosomiasis were interviewed about symptoms, health seeking behaviour and their satisfaction with respect to the provided treatment. Anthelminthic drugs for human and veterinary use obtained from various health care structures were analysed for active pharmaceutical ingredients (API) and quantity, using high pressure liquid chromatography-UV and liquid chromatography combined with tandem mass spectrometry. Most people suffering from schistosomiasis sought treatment at health care centres. Yet, they also consulted informal providers without medical training. Regarding animal health, self-mediated therapy was common to manage suspected livestock fascioliasis. Self-reported treatment satisfaction for human schistosomiasis and trematodiasis treatment outcome in livestock were low. Mobile pastoralists perceived the purchased drugs to be of low quality. Among 33 products locally sold as anthelminthic drugs for human or veterinary use, 27 contained albendazole or mebendazole, varying between 91% and 159% of the labelled amount. Six products were sold loosely with incomplete information and their API could not be identified. No counterfeit anthelminthic drugs were detected. None of the samples contained praziquantel or triclabendazole, the drugs of choice against schistosomiasis and fascioliasis, respectively. The perceived unsatisfactory treatment outcomes in humans and animals infected with trematodes are most likely due to empiric diagnosis and the resulting use of inadequate therapy for human schistosomiasis and the lack of efficacious drugs against livestock fascioliasis.
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Affiliation(s)
- Helena Greter
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Noemi Cowan
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Bongo N Ngandolo
- Institut de Recherche en Elevage pour le Développement, N'Djamena, Chad
| | - Hamit Kessely
- Centre de Support en Santé International, N'Djamena, Chad
| | | | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
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Seck MC, Thwing J, Fall FB, Gomis JF, Deme A, Ndiaye YD, Daniels R, Volkman SK, Ndiop M, Ba M, Ndiaye D. Malaria prevalence, prevention and treatment seeking practices among nomadic pastoralists in northern Senegal. Malar J 2017; 16:413. [PMID: 29029619 PMCID: PMC5640937 DOI: 10.1186/s12936-017-2055-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/05/2017] [Indexed: 12/26/2022] Open
Abstract
Background Malaria transmission in Senegal is highly stratified, from low in the dry north to moderately high in the moist south. In northern Senegal, along the Senegal River Valley and in the Ferlo semi-desert region, annual incidence is less than five cases per 1000 inhabitants. Many nomadic pastoralists have permanent dwellings in the Ferlo Desert and Senegal River Valley, but spend dry season in the south with their herds, returning north when the rains start, leading to a concern that this population could contribute to ongoing transmission in the north. Methods A modified snowball sampling survey was conducted at six sites in northern Senegal to determine the malaria prevention and treatment seeking practices and parasite prevalence among nomadic pastoralists in the Senegal River Valley and the Ferlo Desert. Nomadic pastoralists aged 6 months and older were surveyed during September and October 2014, and data regarding demographics, access to care and preventive measures were collected. Parasite infection was detected using rapid diagnostic tests (RDTs), microscopy (thin and thick smears) and polymerase chain reaction (PCR). Molecular barcodes were determined by high resolution melting (HRM). Results Of 1800 participants, 61% were male. Sixty-four percent had at least one bed net in the household, and 53% reported using a net the night before. Only 29% had received a net from a mass distribution campaign. Of the 8% (142) who reported having had fever in the last month, 55% sought care, 20% of whom received a diagnostic test, one-third of which (n = 5) were reported to be positive. Parasite prevalence was 0.44% by thick smear and 0.50% by PCR. None of the molecular barcodes identified among the nomadic pastoralists had been previously identified in Senegal. Conclusions While access to and utilization of malaria control interventions among nomadic pastoralists was lower than the general population, parasite prevalence was lower than expected and sheds doubt on the perception that they are a source of ongoing transmission in the north. The National Malaria Control Program is making efforts to improve access to malaria prevention and case management for nomadic populations. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-2055-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mame Cheikh Seck
- Department of Parasitology, Faculty of Medicine and Pharmacy, Cheikh Anta Diop University, Dakar, Senegal
| | - Julie Thwing
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, President's Malaria Initiative, Atlanta, GA, USA.
| | - Fatou Ba Fall
- Senegal National Malaria Control Program, Dakar, Senegal
| | - Jules Francois Gomis
- Department of Parasitology, Faculty of Medicine and Pharmacy, Cheikh Anta Diop University, Dakar, Senegal
| | - Awa Deme
- Department of Parasitology, Faculty of Medicine and Pharmacy, Cheikh Anta Diop University, Dakar, Senegal
| | - Yaye Die Ndiaye
- Department of Parasitology, Faculty of Medicine and Pharmacy, Cheikh Anta Diop University, Dakar, Senegal
| | - Rachel Daniels
- Harvard T.H Chan School of Public Health, Boston, MA, USA
| | | | - Medoune Ndiop
- Senegal National Malaria Control Program, Dakar, Senegal
| | - Mady Ba
- Senegal National Malaria Control Program, Dakar, Senegal
| | - Daouda Ndiaye
- Department of Parasitology, Faculty of Medicine and Pharmacy, Cheikh Anta Diop University, Dakar, Senegal
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Sima BT, Belachew T, Abebe F. Knowledge, attitude and perceived stigma towards tuberculosis among pastoralists; Do they differ from sedentary communities? A comparative cross-sectional study. PLoS One 2017; 12:e0181032. [PMID: 28715439 PMCID: PMC5513437 DOI: 10.1371/journal.pone.0181032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ethiopia is ninth among the world high tuberculosis (TB) burden countries, pastoralists being the most affected population. However, there is no published report whether the behavior related to TB are different between pastoralist and the sedentary communities. Therefore, the main aim of this study is to assess the pastoralist community knowledge, attitude and perceived stigma towards tuberculosis and their health care seeking behavior in comparison to the neighboring sedentary communities and this may help to plan TB control interventions specifically for the pastoralist communities. METHOD A community-based cross-sectional survey was carried out from September 2014 to January 2015, among 337 individuals from pastoralist and 247 from the sedentary community of Kereyu district. Data were collected using structured questionnaires. Three focus group discussions were used to collect qualitative data, one with men and the other with women in the pastoralist and one with men in the sedentary groups. Data were analyzed using Statistical Software for Social Science, SPSS V 22 and STATA. RESULTS A Lower proportion of pastoralists mentioned bacilli (bacteria) as the cause of PTB compared to the sedentary group (63.9% vs. 81.0%, p<0.01), respectively. However, witchcraft was reported as the causes of TB by a higher proportion of pastoralists than the sedentary group (53.6% vs.23.5%, p<0.01), respectively. Similarly, a lower proportion of pastoralists indicated PTB is preventable compared to the sedentary group (95.8% vs. 99.6%, p<0.01), respectively. Moreover, majority of the pastoralists mentioned that most people would reject a TB patient in their community compared to the sedentary group (39.9% vs. 8.9%, p<0.001), respectively, and the pastoralists expressed that they would be ashamed/embarrassed if they had TB 68% vs.36.4%, p<0.001), respectively. CONCLUSION The finding indicates that there is a lower awareness about TB, a negative attitude towards TB patients and a higher perceived stigma among pastoralists compared to their neighbor sedentary population. Strategic health communications pertinent to the pastoralists way of life should be planned and implemented to improve the awareness gap about tuberculosis.
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Affiliation(s)
- Bezawit Temesgen Sima
- Public Health and Medical College, Jimma University, Jimma, Ethiopia
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- * E-mail:
| | - Tefera Belachew
- Public Health and Medical College, Jimma University, Jimma, Ethiopia
| | - Fekadu Abebe
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
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West SK, Munoz B, Mkocha H, Dize L, Gaydos CA, Swenor B, Ervin AM, Quinn TC. Treating village newcomers and travelers for trachoma: Results from ASANTE cluster randomized trial. PLoS One 2017; 12:e0178595. [PMID: 28662043 PMCID: PMC5490954 DOI: 10.1371/journal.pone.0178595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/16/2017] [Indexed: 11/19/2022] Open
Abstract
TRIAL DESIGN Trachoma is targeted for global elimination. Infection rates with Chlamydia trachomatis are higher in new arrivals to a community and in travelers who leave for extended periods, suggesting they are sources of re-infection. This community-randomized, clinical trial was designed to determine if a surveillance program that targeted newcomers and travelers, identified weekly, would result in more communities achieving levels of infection of ≤1%. METHODS 52 communities were randomly allocated 1:1 to the control (annual MDA alone if warranted) or intervention arm (annual MDA if warranted, plus a surveillance program to identify and treat newcomers and travelers). In each community, surveys were completed every six months on a random sample of 100 children ages 1-9 years for trachoma and infection. The primary outcome was the proportion of communities in the intervention arm, compared to the control arm, which had a prevalence of infection at ≤1% by 24 months. Registered: clinicaltrials.gov(NCT01767506). RESULTS Intervention communities experienced an average of 110 surveillance events per month. At 24 months, 7 (27%) of 26 intervention communities achieved a prevalence of infection ≤1% compared to 4 (15%) of the 26 control communities (odds ratio = 2·6, 95%CI = 0·56-11·9). At 24 months, the average infection prevalence in the intervention communities was 4·8, compared to 6·9 in the control communities (p = ·06). CONCLUSION Despite surveillance programs for community newcomers and travelers, the proportion of intervention communities with a level of infection ≤1% was lower than expected and not significantly different from control communities.
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Affiliation(s)
- Sheila K. West
- Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore MD, United States of America
| | - Beatriz Munoz
- Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore MD, United States of America
| | | | - Laura Dize
- International Chlamydia Laboratory, Johns Hopkins School of Medicine, Baltimore MD, United States of America
| | - Charlotte A. Gaydos
- International Chlamydia Laboratory, Johns Hopkins School of Medicine, Baltimore MD, United States of America
| | - Bonnie Swenor
- Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore MD, United States of America
| | - Ann-Margret Ervin
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD, United States of America
| | - Thomas C. Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda MD, United States of America
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Kimutai R, Musa AM, Njoroge S, Omollo R, Alves F, Hailu A, Khalil EAG, Diro E, Soipei P, Musa B, Salman K, Ritmeijer K, Chappuis F, Rashid J, Mohammed R, Jameneh A, Makonnen E, Olobo J, Okello L, Sagaki P, Strub N, Ellis S, Alvar J, Balasegaram M, Alirol E, Wasunna M. Safety and Effectiveness of Sodium Stibogluconate and Paromomycin Combination for the Treatment of Visceral Leishmaniasis in Eastern Africa: Results from a Pharmacovigilance Programme. Clin Drug Investig 2017; 37:259-272. [PMID: 28066878 PMCID: PMC5315726 DOI: 10.1007/s40261-016-0481-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In 2010, WHO recommended a new first-line treatment for visceral leishmaniasis (VL) in Eastern Africa. The new treatment, a combination of intravenous (IV) or intramuscular (IM) sodium stibogluconate (SSG) and IM paromomycin (PM) was an improvement over SSG monotherapy, the previous first-line VL treatment in the region. To monitor the new treatment's safety and effectiveness in routine clinical practice a pharmacovigilance (PV) programme was developed. METHODS A prospective PV cohort was developed. Regulatory approval was obtained in Sudan, Kenya, Uganda and Ethiopia. Twelve sentinel sites sponsored by the Ministries of Health, Médecins Sans Frontières (MSF) and Drugs for Neglected Diseases initiative (DNDi) participated. VL patients treated using the new treatment were consented and included in a common registry that collected demographics, baseline clinical characteristics, adverse events, serious adverse events and treatment outcomes. Six-monthly periodic safety update reports (PSUR) were prepared and reviewed by a PV steering committee. RESULTS Overall 3126 patients were enrolled: 1962 (62.7%) from Sudan, 652 (20.9%) from Kenya, 322 (10.3%) from Ethiopia and 190 (6.1%) from Uganda. Patients were mostly male children (68.1%, median age 11 years) with primary VL (97.8%). SSG-PM initial cure rate was 95.1%; no geographical differences were noted. HIV/VL co-infected patients and patients older than 50 years had initial cure rates of 56 and 81.4%, respectively, while 1063 (34%) patients had at least one adverse event (AE) during treatment and 1.92% (n = 60) had a serious adverse event (SAE) with a mortality of 1.0% (n = 32). There were no serious unexpected adverse drug reactions. CONCLUSIONS This first regional PV programme in VL supports SSG-PM combination as first-line treatment for primary VL in Eastern Africa. SSG-PM was effective and safe except in HIV/VL co-infected or older patients. Active PV surveillance of targeted safety, effectiveness and key VL outcomes such us VL relapse, PKDL and HIV/VL co-infection should continue and PV data integrated to national and WHO PV databases.
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Affiliation(s)
- Robert Kimutai
- Centre for Clinical Research, Kenya Medical Research Institute, PO Box 20778-00202, Off Mbagathi Rd, Nairobi, Kenya.
- Drugs for Neglected Diseases Initiative (DNDi), Nairobi, Kenya.
| | - Ahmed M Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Simon Njoroge
- Centre for Clinical Research, Kenya Medical Research Institute, PO Box 20778-00202, Off Mbagathi Rd, Nairobi, Kenya
| | - Raymond Omollo
- Drugs for Neglected Diseases Initiative (DNDi), Nairobi, Kenya
| | - Fabiana Alves
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Asrat Hailu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Peninah Soipei
- Drugs for Neglected Diseases Initiative (DNDi), Nairobi, Kenya
| | - Brima Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Khalid Salman
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | - Francois Chappuis
- Médecins Sans Frontières, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Juma Rashid
- Centre for Clinical Research, Kenya Medical Research Institute, PO Box 20778-00202, Off Mbagathi Rd, Nairobi, Kenya
| | | | - Asfaw Jameneh
- Arba Minch Hospital, Regional Health Bureau of SNNPR State, Arba Minch, Ethiopia
| | - Eyasu Makonnen
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Nathalie Strub
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Sally Ellis
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | | | - Emilie Alirol
- Médecins Sans Frontières, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Monique Wasunna
- Centre for Clinical Research, Kenya Medical Research Institute, PO Box 20778-00202, Off Mbagathi Rd, Nairobi, Kenya
- Drugs for Neglected Diseases Initiative (DNDi), Nairobi, Kenya
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Zuurmond M, Nyapera V, Mwenda V, Kisia J, Rono H, Palmer J. Childhood disability in Turkana, Kenya: Understanding how carers cope in a complex humanitarian setting. Afr J Disabil 2016; 5:277. [PMID: 28730061 PMCID: PMC5433466 DOI: 10.4102/ajod.v5i1.277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although the consequences of disability are magnified in humanitarian contexts, research into the difficulties of caring for children with a disability in such settings has received limited attention. METHODS Based on in-depth interviews with 31 families, key informants and focus group discussions in Turkana, Kenya, this article explores the lives of families caring for children with a range of impairments (hearing, vision, physical and intellectual) in a complex humanitarian context characterised by drought, flooding, armed conflict, poverty and historical marginalisation. RESULTS The challenging environmental and social conditions of Turkana magnified not only the impact of impairment on children, but also the burden of caregiving. The remoteness of Turkana, along with the paucity and fragmentation of health, rehabilitation and social services, posed major challenges and created opportunity costs for families. Disability-related stigma isolated mothers of children with disabilities, especially, increasing their burden of care and further limiting their access to services and humanitarian programmes. In a context where social systems are already stressed, the combination of these factors compounded the vulnerabilities faced by children with disabilities and their families. CONCLUSION The needs of children with disabilities and their carers in Turkana are not being met by either community social support systems or humanitarian aid programmes. There is an urgent need to mainstream disability into Turkana services and programmes.
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Affiliation(s)
- Maria Zuurmond
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | | | | | | | - Hilary Rono
- London School of Hygiene and Tropical Medicine, and Opthalmologist, Kitale, Kenya
| | - Jennifer Palmer
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, UK
- Centre of African Studies, School of Political & Social Sciences, University of Edinburgh, London, UK
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Dierickx S, Gryseels C, Mwesigwa J, O’Neill S, Bannister-Tyrell M, Ronse M, Jaiteh F, Gerrets R, D’Alessandro U, Grietens KP. Factors Associated with Non-Participation and Non-Adherence in Directly Observed Mass Drug Administration for Malaria in The Gambia. PLoS One 2016; 11:e0148627. [PMID: 26866685 PMCID: PMC4750858 DOI: 10.1371/journal.pone.0148627] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/20/2016] [Indexed: 11/27/2022] Open
Abstract
Introduction The potential benefits of Mass Drug Administration (MDA) for malaria elimination are being considered in several malaria endemic countries where a decline in malaria transmission has been reported. For this strategy to work, it is important that a large proportion of the target population participates, requiring an in-depth understanding of factors that may affect participation and adherence to MDA programs. Methodology This social science study was ancillary to a one-round directly observed MDA campaign with dihydroartemisinin-piperaquine, carried out in 12 villages in rural Gambia between June and August 2014. The social science study employed a mixed-methods approach combining qualitative methods (participant observation and in-depth interviewing) and quantitative methods (structured follow-up interviews among non-participating and non-adhering community members). Results Of 3942 people registered in the study villages, 67.9% adhered to the three consecutive daily doses. For the remaining villagers, 12.6% did not attend the screening, 3.5% was not eligible and 16% did not adhere to the treatment schedule. The main barriers for non-participation and adherence were long and short-term mobility of individuals and specific subgroups, perceived adverse drug reactions and rumors, inconveniences related to the logistics of MDA (e.g. waiting times) and the perceived lack of information about MDA. Conclusion While, there was no fundamental resistance from the target communities, adherence was 67.9%. This shows the necessity of understanding local perceptions and barriers to increase its effectiveness. Moreover, certain of the constraining factors were socio-spatially clustered which might prove problematic since focal areas of residual malaria transmission may remain allowing malaria to spread to adjacent areas where transmission had been temporarily interrupted.
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Affiliation(s)
- Susan Dierickx
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
- Rhea, Centre of Expertise Gender, Diversity and Intersectionality, Vrije Universiteit Brussel, Brussels, Belgium
- * E-mail:
| | - Charlotte Gryseels
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
| | | | - Sarah O’Neill
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Maya Ronse
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Fatou Jaiteh
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Medical Research Council Unit, Fajara, The Gambia
| | - René Gerrets
- Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
| | - Umberto D’Alessandro
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Medical Research Council Unit, Fajara, The Gambia
- London School of Tropical Medicine and Hygiene, London, Unoted Kingdom
| | - Koen Peeters Grietens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Gore-Langton GR, Mungai J, Alenwi N, Abagira A, Bicknell OM, Harrison RE, Hassan FA, Munga S, Eves K, Juma E, Allan R. Investigating a Non-Mesh Mosquito Net Among Outdoor Sleeping Nomadic Communities in Kenya. Am J Trop Med Hyg 2015; 93:1002-1009. [PMID: 26416107 PMCID: PMC4703291 DOI: 10.4269/ajtmh.14-0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 06/15/2015] [Indexed: 11/17/2022] Open
Abstract
Rising reports of exophagic malaria vectors make even more pressing the need for alternatives to traditional, mesh, long-lasting insecticidal nets (LLINs) designed for indoor sleeping and often inadequate in the protection of outdoor-sleeping populations. This study tests and evaluates the retention, utilization, and durability of novel, non-mesh nets designed for outdoor use. Longitudinal, cross-sectional surveys were conducted, the physical condition of nets was assessed, and bio-efficacy and insecticide content were tested. At 22 months, retention was 98.0%; 97.1% of nets fell within the World Health Organization (WHO) category of being in “good” condition; none were in the “torn” category. At 18 months post-distribution, 100% of nets had at least WHO Pesticide Evaluation Scheme (WHOPES)-acceptable levels of insecticide, this proportion was 66.7% at 22 months. This novel mosquito net has the potential to provide a durable and context-specific tool to prevent malaria among traditionally hard-to-protect and highly vulnerable populations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Richard Allan
- *Address correspondence to Richard Allan, The MENTOR Initiative, The Pinnacle Central Court Station Way, Crawley RH 10I JH, United Kingdom. E-mail:
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Brieger WR, Sommerfeld JU, Amazigo UV. The Potential for Community-Directed Interventions: Reaching Underserved Populations in Africa. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2015; 35:295-316. [PMID: 26470395 DOI: 10.1177/0272684x15592757] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Community-directed interventions (CDIs) have the potential for fulfilling the promise of primary health care by reaching underserved populations in various settings. CDI has been successfully tested by expanding access to additional health services like malaria case management through local effort in communities where ivermectin distribution is ongoing. The question remains whether the CDI approach has potential in communities that do not have a foundation of community-directed treatment with ivermectin. The UNICEF/UNDP/World Bank/WHO Special Program of Research and Training in Tropical Diseases commissioned three sets of formative studies to explore the potential for introducing CDI among nomads, urban poor, and rural areas with no community-directed treatment with ivermectin. This article reviews their findings. Community and health system respondents identified a set of mainly communicable diseases that could be adapted to CDI as well as participatory mechanisms like community-based organizations and leaders that could form a foundation for local organizing and participation. It is hoped that the results of these formative studies will spur further research on CDI among peoples with poor health-care access.
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Affiliation(s)
- William R Brieger
- Department of International Health, Health System Program, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Johannes U Sommerfeld
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Uche V Amazigo
- African Program for Onchocerciasis Control, World Health Organization, Ouagadougou, Burkina Faso
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Jillo JA, Ofware PO, Njuguna S, Mwaura-Tenambergen W. Effectiveness of Ng'adakarin Bamocha model in improving access to ante-natal and delivery services among nomadic pastoralist communities of Turkana West and Turkana North Sub-Counties of Kenya. Pan Afr Med J 2015; 20:403. [PMID: 26301007 PMCID: PMC4524908 DOI: 10.11604/pamj.2015.20.403.4896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 04/01/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Access to maternal and child health care services among the nomadic pastoralists community in Kenya and African continent in general is unacceptably low. In Turkana, only 18.1% of the women had seen a nurse or a midwife for antenatal care during pregnancy while only 1.3% of pregnant women reported delivery at health facilities in 2005. Ng'adakarin BAMOCHA model, based on migratory routes of the Turkana pastoralists and container clinics was adopted in 2007 to improve access to maternal and child health services by the nomads. METHODS A cross-sectional study design was used to establish the effectiveness of Ng'adakarin BAMOCHA model on accessibility and uptake of ante-natal care and delivery services. A total of 360 households and 400 households were interviewed for pre-intervention and post-intervention respectively. The study compared the pre-intervention and post-intervention findings. Structured questionnaires and focus group discussion were used for data collection. RESULTS There was no improvement in the fourth ante-natal care visits between pre-intervention and post-intervention groups at 119(51.5%) and 111(41.9%) respectively (p < 0.05). Knowledge of the community on the importance of ANC visits improved from 60%-72% with significance level of p < 0.05. There was a significant increase 6%-17% of deliveries under a skilled health worker (p < 0.05). TBA assisted deliveries increased from 7.5%- 20.2% with a p < 0.05. There was significant reduction in home deliveries from 89.5%-79.5% with a p < 0.05. CONCLUSION The Ng'adakarin Bamocha model had a positive effect on the improving maternal health care among the nomadic pastoralist community in Turkana.
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Affiliation(s)
- Jillo Ali Jillo
- Department of Health Systems Management and Medical Education, Kenya Methodist University, Nairobi, Kenya ; Amref Health Africa, Kenya Country office, Nairobi, Kenya
| | | | - Susan Njuguna
- Department of Health Systems Management and Medical Education, Kenya Methodist University, Nairobi, Kenya
| | - Wanja Mwaura-Tenambergen
- Department of Health Systems Management and Medical Education, Kenya Methodist University, Nairobi, Kenya
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Ag Ahmed MA. Des agents de santé communautaires pour la promotion de la santé des pasteurs nomades au Mali. Glob Health Promot 2015; 23:80-84. [PMID: 25852121 DOI: 10.1177/1757975915573879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Au Mali, les nomades (des Maures, Touaregs et Peulhs) représentent environ 1,25 million de personnes. Les services de santé leur sont peu accessibles en raison de leur mobilité, liée à leur activité d'élevage. La question que se posent plusieurs intervenants en santé publique des pays où vivent ces nomades est de savoir comment améliorer leur santé. Dans ce commentaire, après un bref exposé des problèmes liés à l'accès aux services de santé, nous proposons une approche innovante et holistique de la santé, qui soutient que des agents de santé communautaires (ASC) pourraient contribuer à améliorer la santé des nomades en offrant conjointement des services de santé aux nomades et à leurs animaux (le concept « One Health » [d'Une Seule Santé]). Des pistes de réflexion sont dégagées, quant aux principaux défis pour leur efficacité et durabilité, qui sont la conception et gestion du programme, leur soutien par les communautés et leur intégration aux services de santé publique et vétérinaire.
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Muga GO, Onyango-Ouma W, Sang R, Affognon H. Sociocultural and economic dimensions of Rift Valley fever. Am J Trop Med Hyg 2015; 92:730-738. [PMID: 25688166 PMCID: PMC4385765 DOI: 10.4269/ajtmh.14-0363] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022] Open
Abstract
Health researchers have advocated for a cross-disciplinary approach to the study and prevention of infectious zoonotic diseases, such as Rift Valley Fever. It is believed that this approach can help bring out the social determinants and effects of the zoonotic diseases for the design of appropriate interventions and public health policy. A comprehensive literature review using a systematic search strategy was undertaken to explore the sociocultural and economic factors that influence the transmission and spread of Rift Valley Fever. Although the findings reveal a paucity of social research on Rift Valley Fever, they suggest that livestock sacrificial rituals, food preparation and consumption practices, gender roles, and inadequate resource base for public institutions are the key factors that influence the transmission. It is concluded that there is need for cross-disciplinary studies to increase the understanding of Rift Valley Fever and facilitate appropriate and timely response and mitigation measures.
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Affiliation(s)
- Geoffrey Otieno Muga
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya; International Centre for Insect Physiology and Ecology, Nairobi, Kenya
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