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Means AR, Ásbjörnsdóttir KH, Sharrock KC, Galagan SR, Aruldas K, Avokpaho E, Chabi F, Halliday KE, Houngbegnon P, Israel GJ, Kaliappan SP, Kennedy D, Legge H, Oswald WE, Palanisamy G, Rogers E, Timothy J, Pearman E, Ramesh RM, Simwanza J, Sheik-Abdullah JF, Sheikh M, Togbevi CI, Witek-McManus S, Pullan RL, Bailey R, Kalua K, Ibikounlé M, Luty AJF, Ajjampur SSR, Walson JL. Coverage of community-wide mass drug administration platforms for soil-transmitted helminths in Benin, India, and Malawi: findings from the DeWorm3 project. Infect Dis Poverty 2024; 13:72. [PMID: 39380086 PMCID: PMC11460046 DOI: 10.1186/s40249-024-01241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 09/12/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) affect approximately 1.5 billion people globally. The current STH control strategy is annual or twice-annual preventive chemotherapy, typically school-based deworming targeting children and women of reproductive age. Mathematical modeling suggests that it may be possible to interrupt STH transmission through high-coverage community-wide mass drug administration (cMDA). DeWorm3 is a cluster randomized trial testing cMDA for prevalence reduction and transmission interruption. The purpose of this study is to describe coverage of cMDA in study clusters over time and correlates of coverage at individual and cluster levels. METHODS From 2018-2020, DeWorm3 delivered six rounds of cMDA with 400 mg albendazole at sites in Benin, India, and Malawi. We report coverage, treatment uptake, and directly observed therapy across all rounds. Factors associated with coverage at the cluster level were identified using binomial generalized estimating equations, while factors associated with non-treatment at the individual level were identified using binomial mixed-effects models. RESULTS Coverage was high across all clusters and rounds, exceeding the WHO target of 75% in all sites and across all rounds (78% to 95%); cluster-level coverage tended to increase over time. Younger, unmarried, and migratory adults were more likely to be untreated at all sites; adult males were more likely to be untreated in Benin and Malawi. Among children, girls were more likely to be untreated, as were non-school-attending and migratory children. Higher adult education was associated with greater odds of non-treatment among adults, but lower odds among children in the household. Belonging to a less wealthy or minority language-speaking household was associated with non-treatment among both adults and children. CONCLUSIONS It is possible to deliver community-wide MDA with high coverage. Unique individual and community-level factors influence treatment across settings, and these may be addressed through targeted programming. TRIAL REGISTRATION Field Studies on the Feasibility of Interrupting the Transmission of Soil-transmitted Helminths (STH), NCT03014167.
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Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA.
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA.
| | - Kristjana Hrönn Ásbjörnsdóttir
- Centre of Public Health Sciences, University of Iceland, Reykjavík, Iceland
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | - Katherine C Sharrock
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | - Sean R Galagan
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Félicien Chabi
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Bénin
| | - Katherine E Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Gideon John Israel
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - David Kennedy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Hugo Legge
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - William E Oswald
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Global Health Division, International Development Group, Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA
| | - Gokila Palanisamy
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Elliott Rogers
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Division of Medicine, University College London, London, UK
| | - Joseph Timothy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Pearman
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | - Rohan Michael Ramesh
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - James Simwanza
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Jasmine Farzana Sheik-Abdullah
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Mariyam Sheikh
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | | | - Stefan Witek-McManus
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L Pullan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Robin Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Moudachirou Ibikounlé
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Bénin
- Tropical Infectious Diseases Research Center (TIDRC)Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Adrian J F Luty
- Université Paris Cité, Institut de Recherche pour le Développement, MERIT, Paris, F-75006, France
| | - Sitara S R Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Judd L Walson
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Witek-McManus S, Simwanza J, Msiska R, Mangawah H, Oswald W, Timothy J, Galagan S, Pearman E, Shaikh M, Legge H, Walson J, Juziwelo L, Davey C, Pullan R, Bailey RL, Kalua K, Kuper H. Disability in childhood and the equity of health services: a cross-sectional comparison of mass drug administration strategies for soil-transmitted helminths in southern Malawi. BMJ Open 2024; 14:e083321. [PMID: 39242171 PMCID: PMC11381638 DOI: 10.1136/bmjopen-2023-083321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND School-based approaches are an efficient mechanism for the delivery of basic health services, but may result in the exclusion of children with disabilities if they are less likely to participate in schooling. Community-based 'door to door' approaches may provide a more equitable strategy to ensure that children with disabilities are reached, but disability is rarely assessed rigorously in the evaluation of health interventions. OBJECTIVES To describe the prevalence and factors associated with disability among children aged 5-17 years and to assess the relative effectiveness of routine school-based deworming (SBD) compared with a novel intervention of community-based deworming (CBD) in treating children with disabilities for soil-transmitted helminths. SETTING DeWorm3 Malawi Site (DMS), Mangochi district, Malawi. PARTICIPANTS All 44 574 children aged 5-17 years residing within the DMS. PRIMARY AND SECONDARY OUTCOME MEASURES Disability was defined as a functional limitation in one or more domains of the Washington Group/UNICEF Child Functioning Module administered as part of a community-based census. Treatment of all children during SBD and CBD was independently observed and recorded. For both intervention types, we performed bivariate analyses (z-score) of the absolute proportion of children with and without disabilities treated (absolute differences (ADs) in receipt of treatment), and logistic regression to examine whether disability status was associated with the likelihood of treatment (relative differences in receipt of treatment). RESULTS The overall prevalence of disability was 3.3% (n=1467), and the most common domains of disability were hearing, remembering and communication. Boys were consistently more likely to have a disability compared with girls at all age groups, and disability was strongly associated with lower school attendance and worse levels of education. There was no significant difference in the proportion of children with disabilities treated during SBD when assessed by direct observation (-1% AD, p=0.41) or likelihood of treatment (adjusted risk ratio (aRR)=1.07, 95% CI 0.89 to 1.28). Treatment of all children during CBD was substantially higher than SBD, but again showed no significant difference in the proportions treated (-0.5% AD, p=0.59) or likelihood of treatment (aRR=1.04, 95% CI 0.99 to 1.10). CONCLUSION SBD does not appear to exclude children with disabilities, but the effect of consistently lower levels of educational participation of children with disabilities should be actively considered in the design and monitoring of school health interventions. TRIAL REGISTRATION NUMBER NCT03014167.
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Affiliation(s)
- Stefan Witek-McManus
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - James Simwanza
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | - Rejoice Msiska
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - William Oswald
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Timothy
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Sean Galagan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Emily Pearman
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Mariyam Shaikh
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Hugo Legge
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health & Population, Lilongwe, Malawi
| | - Calum Davey
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Pullan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Robin L Bailey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hannah Kuper
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Saxena M, Roll A, Walson JL, Pearman E, Legge H, Nindi P, Chirambo CM, Titus A, Johnson J, Bélou EA, Togbevi CI, Chabi F, Avokpaho E, Kalua K, Ajjampur SSR, Ibikounlé M, Aruldas K, Means AR. "Our desire is to make this village intestinal worm free": Identifying determinants of high coverage of community-wide mass drug administration for soil transmitted helminths in Benin, India, and Malawi. PLoS Negl Trop Dis 2024; 18:e0011819. [PMID: 38319937 PMCID: PMC10846705 DOI: 10.1371/journal.pntd.0011819] [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: 04/18/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Soil-transmitted helminth infections (STH) are associated with substantial morbidity in low-and-middle-income countries, accounting for 2.7 million disability-adjusted life years annually. Current World Health Organization guidelines recommend controlling STH-associated morbidity through periodic deworming of at-risk populations, including children and women of reproductive age (15-49 years). However, there is increasing interest in community-wide mass drug administration (cMDA) which includes deworming adults who serve as infection reservoirs as a method to improve coverage and possibly to interrupt STH transmission. We investigated determinants of cMDA coverage by comparing high-coverage clusters (HCCs) and low-coverage clusters (LCCs) receiving STH cMDA in three countries. METHODS A convergent mixed-methods design was used to analyze data from HCCs and LCCs in DeWorm3 trial sites in Benin, India, and Malawi following three rounds of cMDA. Qualitative data were collected via 48 community-level focus group discussions. Quantitative data were collected via routine activities nested within the DeWorm3 trial, including annual censuses and coverage surveys. The Consolidated Framework for Implementation Research (CFIR) guided coding, theme development and a rating process to determine the influence of each CFIR construct on cMDA coverage. RESULTS Of 23 CFIR constructs evaluated, we identified 11 constructs that differentiated between HCCs and LCCs, indicating they are potential drivers of coverage. Determinants differentiating HCC and LCC include participant experiences with previous community-wide programs, communities' perceptions of directly observed therapy (DOT), perceptions about the treatment uptake behaviors of neighbors, and women's agency to make household-level treatment decisions. CONCLUSION The convergent mixed-methods study identified barriers and facilitators that may be useful to NTD programs to improve cMDA implementation for STH, increase treatment coverage, and contribute to the successful control or elimination of STH. TRIAL REGISTRATION The parent trial was registered at clinicaltrials.gov (NCT03014167).
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Affiliation(s)
- Malvika Saxena
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Amy Roll
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
- The DeWorm3 Project, Seattle, Washington, United States of America
| | - Emily Pearman
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- The DeWorm3 Project, Seattle, Washington, United States of America
| | - Hugo Legge
- The DeWorm3 Project, Seattle, Washington, United States of America
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Providence Nindi
- Blantyre Institute for Community Outreach (BICO), Lions Sight First Eye Hospital, Blantyre, Malawi
| | | | - Angelin Titus
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jabaselvi Johnson
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | | | - Félicien Chabi
- Institut de Recherche Clinique du Benin, Abomey-Calavi, Benin
| | | | - Khumbo Kalua
- Blantyre Institute for Community Outreach (BICO), Lions Sight First Eye Hospital, Blantyre, Malawi
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sitara Swarna Rao Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Moudachirou Ibikounlé
- Institut de Recherche Clinique du Benin, Abomey-Calavi, Benin
- Centre de Recherche pour la lutte contre les Maladies Infectieuses Tropicales (CReMIT/TIDRC), Université d’Abomey-Calavi, Abomey-Calavi, Benin
| | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- The DeWorm3 Project, Seattle, Washington, United States of America
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Niang M, Alami H, Gagnon MP, Dupéré S. A conceptualisation of scale-up and sustainability of social innovations in global health: a narrative review and integrative framework for action. Glob Health Action 2023; 16:2230813. [PMID: 37459240 DOI: 10.1080/16549716.2023.2230813] [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: 03/25/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The scale-up and sustainability of social innovations for health have received increased interest in global health research in recent years; however, these ambiguous concepts are poorly defined and insufficiently theorised and studied. Researchers, policymakers, and practitioners lack conceptual clarity and integrated frameworks for the scale-up and sustainability of global health innovations. Often, the frameworks developed are conceived in a linear and deterministic or consequentialist vision of the diffusion of innovations. This approach limits the consideration of complexity in scaling up and sustaining innovations. OBJECTIVE By using a systems theory lens and conducting a narrative review, this manuscript aims to produce an evidence-based integrative conceptual framework for the scale-up and sustainability of global health innovations. METHOD We conducted a hermeneutic narrative review to synthetise different definitions of scale-up and sustainability to model an integrative definition of these concepts for global health. We have summarised the literature on the determinants that influence the conditions for innovation success or failure while noting the interconnections between internal and external innovation environments. RESULTS The internal innovation environment includes innovation characteristics (effectiveness and testability, monitoring and evaluation systems, simplification processes, resource requirements) and organisational characteristics (leadership and governance, organisational change, and organisational viability). The external innovation environment refers to receptive and transformative environments; the values, cultures, norms, and practices of individuals, communities, organisations, and systems; and other contextual characteristics relevant to innovation development. CONCLUSION From these syntheses, we proposed an interconnected framework for action to better guide innovation researchers, practitioners, and policymakers in incorporating complexity and systemic interactions between internal and external innovation environments in global health.
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Affiliation(s)
- Marietou Niang
- Department of Social Work and Psychosociology, Université du Québec à Rimouski, Lévis, QC, Canada
| | - Hassane Alami
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | | | - Sophie Dupéré
- Faculty of Nursing Science, Université Laval, Québec, QC, Canada
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Arney JK, Headland MK, Bertone AM, Meite A, Ettiegne-Traore V, Asemanyi-Mensah K, Dede Teiko Dzathor I, Kargbo-Labour I, Jalloh U, Houck P, Stukel D. Synthesis of findings from the literature and a qualitative research study on the impacts of gender, disability, and ethnicity in Neglected Tropical Diseases programs. PLoS Negl Trop Dis 2023; 17:e0011782. [PMID: 38048347 PMCID: PMC10721307 DOI: 10.1371/journal.pntd.0011782] [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: 05/25/2023] [Revised: 12/14/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION Act to End NTDs | West, a USAID-funded program that supports national governments to eliminate or control five neglected tropical diseases (NTDs) in West Africa including trachoma, lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminthiasis, conducted a gender and social inclusion analysis to determine how NTDs differentially impact various populations and how gender and social norms impact NTD programs to inform future programming. METHODS The study used a mixed methods approach including a literature review; primary qualitative data collection; and monitoring data in Côte d'Ivoire, Sierra Leone, and Ghana. RESULTS Women and girls face additional health risks from many NTDs compared to men and boys. In addition to differential health burden, the social and economic impacts of NTD-related disability or infertility can be particularly dire for women and girls. Men were somewhat less likely to participate in mass drug administration (MDAs) due to: lack of information about campaigns, lack of access due to work, and higher levels of mistrust of the government and concerns about side effects of the medicines. Pregnant and breastfeeding women were sometimes excluded by community drug distributors (CDDs) from certain types of MDAs for which they are eligible. Training participation rates for CDDs and supervisors were nearly universally higher for men than women, even though feedback on the effectiveness of female CDDs was overwhelmingly positive, and female CDDs often have more access to other women in conservative households. The role of a CDD can lead to career and social opportunities for women. However, challenges faced by CDDs were seen as a greater barrier for women, including transportation, safety, household responsibilities, lower education levels, and low or lack of wages. DISCUSSION Programs to address NTDs can promote equity and improve programming by increasing women's participation as CDDs and providing financial compensation. Additionally, programs should prioritize inclusive training for CDDs, and inclusive messaging about MDA for communities.
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Affiliation(s)
| | | | | | - Aboulaye Meite
- Programme National de Lutte Contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministry of Health, Abidjan, Côte d’Ivoire
| | | | - Kofi Asemanyi-Mensah
- Neglected Tropical Diseases Programme, Disease Control and Prevention Department, Ghana Health Service, Public Health Division, Accra, Ghana
| | | | - Ibrahim Kargbo-Labour
- Neglected Tropical Disease Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Umu Jalloh
- Helen Keller International, Freetown, Sierra Leone
| | - Patricia Houck
- Helen Keller International, NYC, New York, United States of America
| | - Diana Stukel
- FHI 360, Washington, DC, United States of America
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Shomuyiwa DO, George NS, Sunday BA, Omotayo FO, Mwaba M, David SC, Nabiryo M, Yangaza Y. Addressing neglected tropical diseases in Africa: A gender perspective. Health Sci Rep 2023; 6:e1726. [PMID: 38028711 PMCID: PMC10654375 DOI: 10.1002/hsr2.1726] [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: 09/03/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
This article delves into the interplay of neglected tropical diseases (NTDs) and Sustainable Development Goals (SDGs) within Africa, spotlighting gender disparities in NTD programs. NTDs, impacting marginalized communities, impose considerable physical, mental, and social burdens. The article underscores NTDs as equity markers for SDGs, spotlighting gender-based imbalances in disease susceptibility, treatment accessibility, and health-seeking tendencies. Gender's influence on NTD risks is elucidated, emphasizing the heightened susceptibility of women due to socioeconomic constraints, cultural dynamics, and gender norms. The article also highlights the absence of gender considerations in NTD programs, advocating for gender-integrated strategies, enhanced data collection, and collaborative partnerships to rectify these inequities. By embracing a gender-equity approach, the article underscores the necessity of gender-balanced NTD efforts for comprehensive health, sustainable development, and gender parity, demanding cohesive actions across sectors.
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Affiliation(s)
| | - Nsikakabasi S. George
- School of Heath and Related ResearchThe University of SheffieldSheffieldUK
- École des hautes études en santé publiqueRennesFrance
| | | | - Faith O. Omotayo
- Faculty of Pharmaceutical SciencesUniversity of NigeriaNsukkaEnuguNigeria
- Department of Public and Community Health ScienceUniversity of the PeopleCaliforniaUSA
| | | | - Success C. David
- Faculty of Pharmaceutical SciencesUniversity of NigeriaNsukkaEnuguNigeria
| | - Maxencia Nabiryo
- Integrated Community Health Initiative OrganizationKampalaUganda
- Makerere University School of Public HealthKampalaUganda
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Gruninger SK, Rasamoelina T, Rakotoarivelo RA, Razafindrakoto AR, Rasolojaona ZT, Rakotozafy RM, Soloniaina PR, Rakotozandrindrainy N, Rausche P, Doumbia CO, Jaeger A, Zerbo A, von Thien H, Klein P, van Dam G, Tannich E, Schwarz NG, Lorenz E, May J, Rakotozandrindrainy R, Fusco D. Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study. Infect Dis Poverty 2023; 12:44. [PMID: 37098581 PMCID: PMC10127445 DOI: 10.1186/s40249-023-01094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/09/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC. METHODS In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios. RESULTS The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection. CONCLUSIONS Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.
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Affiliation(s)
- Sarah Katharina Gruninger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | - Rivo Andry Rakotoarivelo
- Department of Infectious Diseases, University of Fianarantsoa Andrainjato, 301, Fianarantsoa, Madagascar
| | | | | | - Rodson Morin Rakotozafy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar
| | | | - Njary Rakotozandrindrainy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar
| | - Pia Rausche
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Cheick Oumar Doumbia
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- University Clinical Research Centre (UCRC), University of Sciences Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Anna Jaeger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Alexandre Zerbo
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Heidrun von Thien
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Philipp Klein
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Govert van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Egbert Tannich
- National Reference Centre for Tropical Pathogens (NRC), Hamburg, Germany
| | - Norbert Georg Schwarz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Department of Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Daniela Fusco
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.
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8
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Fuller BB, Harris V, Parker C, Martinez A, Toubali E, Ebene BC, Asemanyi-Mensah K, Dembele M, Salissou AB, Kabré C, Meite A, Kane NM, Kargbo-Labour I, Batcho W, Diaby A, Yevstigneyeva V, Stukel DM. Contextual determinants of mass drug administration performance: Modelling fourteen years of lymphatic filariasis treatments in West Africa. PLoS Negl Trop Dis 2023; 17:e0011146. [PMID: 36827450 PMCID: PMC9994721 DOI: 10.1371/journal.pntd.0011146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 03/08/2023] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Effective mass drug administration (MDA) is the cornerstone in the elimination of lymphatic filariasis (LF) and a critical component in combatting all neglected tropical diseases for which preventative chemotherapy is recommended (PC-NTDs). Despite its importance, MDA coverage, however defined, is rarely investigated systematically across time and geography. Most commonly, investigations into coverage react to unsatisfactory outcomes and tend to focus on a single year and health district. Such investigations omit more macro-level influences including sociological, environmental, and programmatic factors. The USAID NTD database contains measures of performance from thousands of district-level LF MDA campaigns across 14 years and 10 West African countries. Specifically, performance was measured as an MDA's epidemiological coverage, calculated as persons treated divided by persons at risk. This analysis aims to explain MDA coverage across time and geography in West Africa using sociological, environmental, and programmatic factors. METHODOLOGY The analysis links epidemiological coverage data from 3,880 LF MDAs with contextual, non-NTD data via location (each MDA was specific to a health district) and time (MDA month, year). Contextual data included rainfall, temperature, violence or social unrest, COVID-19, the 2014 Ebola outbreak, road access/isolation, population density, observance of Ramadan, and the number of previously completed MDAs. PRINCIPAL FINDINGS We fit a hierarchical linear regression model with coverage as the dependent variable and performed sensitivity analyses to confirm the selection of the explanatory factors. Above average rainfall, COVID-19, Ebola, violence and social unrest were all significantly associated with lower coverage. Years of prior experience in a district and above average temperature were significantly associated with higher coverage. CONCLUSIONS/SIGNIFICANCE These generalized and context-focused findings supplement current literature on coverage dynamics and MDA performance. Findings may be used to quantify typically anecdotal considerations in MDA planning. The model and methodology are offered as a tool for further investigation.
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Affiliation(s)
- Brian B. Fuller
- Helen Keller International, Washington, District of Columbia, United States of America
- * E-mail:
| | - Vance Harris
- FHI 360, Denver, Colorado, United States of America
| | - Caleb Parker
- FHI 360, Durham, North Carolina, United States of America
| | | | - Emily Toubali
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, District of Columbia, United States of America
| | - Blandine Clarisse Ebene
- National Programme for Onchocerciasis and Lymphatic Filariasis Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Kofi Asemanyi-Mensah
- Neglected Tropical Diseases Programme, Disease Control and Prevention Department, Ghana Health Service, Public Health Division, Accra, Ghana
| | - Massitan Dembele
- National Programme for the Elimination of LF, Ministry of Health, Bamako, Mali
| | | | - Cathérine Kabré
- Programme national de lutte contre les maladies tropicales négligées, Ministry of Health, Ouagadougou, Burkina Faso
| | - Aboulaye Meite
- Programme national de lutte contre les maladies tropicales négligées à chimiothérapie préventive, Ministry of Health, Abidjan, Côte d’Ivoire
| | - Ndeye Mbacke Kane
- National Neglected Tropical Diseases Control Program, Ministry of Health, Dakar, Senegal
| | - Ibrahim Kargbo-Labour
- Neglected Tropical Disease Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministry of Health, Cotonou, Benin
| | - Aissatou Diaby
- National Neglected Tropical Diseases Control Program, Ministry of Health, Conakry, Guinea
| | - Violetta Yevstigneyeva
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, District of Columbia, United States of America
| | - Diana Maria Stukel
- Act to End NTDs | West, FHI 360, Washington, District of Columbia, United States of America
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9
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Sule MN, Mosha J, Soboka TE, Kinung'hi SM, Sfynia C, Rafiq K, Dower A, Comparet M, Bewley E, Angelo T, Beshah FZ, Templeton MR. A novel theatre-based behaviour change approach for influencing community uptake of schistosomiasis control measures. Parasit Vectors 2022; 15:301. [PMID: 36008841 PMCID: PMC9406251 DOI: 10.1186/s13071-022-05421-5] [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: 03/04/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Appropriate behaviour change with regard to safe water contact practices will facilitate the elimination of schistosomiasis as a public health concern. Various approaches to effecting this change have been trialled in the field but with limited sustainable outcomes. Our case study assessed the effectiveness of a novel theatre-based behaviour change technique (BCT), in combination with cohort awareness raising and capacity training intervention workshops. Methodology Our study was carried out in four rural communities in the Mwanza region of Tanzania and in the semi-urban town of Kemise, Ethiopia. We adapted the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) framework and four phases using a mixed methods approach. Participatory project phase engagement and qualitative formative data were used to guide the design of an acceptable, holistic intervention. Initial baseline (BL) data were collected using quantitative questionnaire surveys with 804 participants in Tanzania and 617 in Ethiopia, followed by the theatre-based BCT and capacity training intervention workshops. A post-intervention (PI) survey was carried out after 6 months, with a participant return rate of 65% in Tanzania and 60% in Ethiopia. Results The intervention achieved a significant improvement in the knowledge of schistosomiasis transmission being associated with poorly managed sanitation and risky water contact. Participants in Tanzania increased their uptake of preventive chemotherapy (males: BL, 56%; PI, 73%, females: BL, 43%; PI, 50%). There was a significant increase in the selection of sanitation (Tanzania: BL, 13%; PI, 21%, Ethiopia: BL, 63%; PI, 90%), safe water and avoiding/minimising contact with infested waters as prevention methods in Tanzania and Ethiopia. Some of the participants in Tanzania followed on from the study by building their own latrines. Conclusions This study showed that substantial positive behaviour changes in schistosomiasis control can be achieved using theatre-based BCT intervention and disease awareness training. With the appropriate sensitisation, education and stakeholder engagement approaches, community members were more open to minimising risk-associated contact with contaminated water sources and were mobilised to implement preventive measures. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05421-5.
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Affiliation(s)
- May N Sule
- Department of Civil and Environmental Engineering, Imperial College London, London, UK. .,Cranfield Water Science Institute, School of Water, Energy and Environment, Cranfield University, Bedford, UK. .,School of Geography and the Environment, University of Oxford, Oxford, UK.
| | - Justina Mosha
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Teshome Emana Soboka
- Africa Centre of Excellence for Water Management, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Safari M Kinung'hi
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Chrysoula Sfynia
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | | | | | | | - Emma Bewley
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Teckla Angelo
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Feleke Zewge Beshah
- Africa Centre of Excellence for Water Management, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael R Templeton
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
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10
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Abila DB, Wasukira SB, Ainembabazi P, Wabinga H. Burden of Risk Factors for Cervical Cancer Among Women Living in East Africa: An Analysis of the Latest Demographic Health Surveys Conducted Between 2014 and 2017. JCO Glob Oncol 2021; 7:1116-1128. [PMID: 34264750 PMCID: PMC8457811 DOI: 10.1200/go.21.00123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In East Africa, cervical cancer is a leading cause of morbidity and mortality among women diagnosed with cancer. In this study, we describe the burden of risk factors for cervical cancer among women of reproductive age in five East African countries.
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Affiliation(s)
- Derrick Bary Abila
- Makerere University, College of Health Sciences, Kampala, Uganda.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | | | - Provia Ainembabazi
- Makerere University, College of Health Sciences, Kampala, Uganda.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Henry Wabinga
- Makerere University, College of Health Sciences, Kampala, Uganda
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11
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Asfaw MA, Hailu C, Beyene TJ. Evaluating Equity and Coverage in Mass Drug Administration for Soil-Transmitted Helminth Infections among School-Age Children in the Hard-to-Reach Setting of Southern Ethiopia. Pediatric Health Med Ther 2021; 12:325-333. [PMID: 34267576 PMCID: PMC8275865 DOI: 10.2147/phmt.s316194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are prevalent in most developing countries, including Ethiopia, with school-age children (SAC) at high risk of infection. In Ethiopia, despite substantial progress being made on mass drug administration (MDA) coverage for STH infections, its implementation is facing challenges in hard-to-reach areas. This study thus aimed at assessing equity and coverage in MDA and identifying factors associated with drug coverage for STH infections among SAC in the hard-to-reach setting of southern Ethiopia. METHODS A community-based cross-sectional survey was conducted in the North Ari district, South Omo Zone in July 2019. Sample size was estimated following WHO drug-coverage evaluation guidelines. Factors associated with drug uptake for STH infections were identified using multivariate logistic regression. RESULTS Of 956 SAC participating in this study, the overall MDA coverage for STH was found to be 27.5% (95% CI 24.7%-30.5%). The odds of having taken drugs were highest among school-enrolled children and in those who knew the purpose of MDA: about about double their counterparts. In contrast, the odds of drug uptake were lower by 69% among those who had got informed only when the drugs delivered and by 92% among those who needed to travel >30 minutes to reach drug-distribution points than their counterparts. CONCLUSION Achieving effective and equitable MDA coverage is facing serious challenges in the hard-to-reach setting of southern Ethiopia. The very low (27.5%) and inequitable MDA coverage found in this study are associated with school nonenrollment, inaccessibility, and lack of information, awareness, and mobilization. Social mobilization should be scaled up to inform and create awareness in the community ahead of MDA. Further, school-based deworming in settings with low school enrollment needs a modified strategy to reach those in need of drugs.
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Affiliation(s)
- Mekuria Asnakew Asfaw
- Collaborative Research and Training Centre for NTDs, Arba Minch University, Arba Minch, Ethiopia
| | - Chernet Hailu
- Jimma University, Faculty of Public Health, Department of Epidemiology, Jimma, Ethiopia
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Research Institute at Nationwide Children’s Hospital, Columbus, OH, 43015, USA
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12
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Woldeyohannes D, Sahiledengle B, Tekalegn Y, Hailemariam Z. Prevalence of Schistosomiasis (S. mansoni and S. haematobium) and its association with gender of school age children in Ethiopia: A systematic review and meta-analysis. Parasite Epidemiol Control 2021; 13:e00210. [PMID: 33842698 PMCID: PMC8020476 DOI: 10.1016/j.parepi.2021.e00210] [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: 01/04/2020] [Revised: 01/12/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Schistosomiasis (S. mansoni and S. haematobium) is an important neglected tropical disease in sub-Saharan Africa including Ethiopia. In Ethiopia, Schistosomiasis has been prioritized as neglected tropical disease and remained among major public health burden on school age children of the country. Few studies conducted on the association between prevalence of Schistosomiasis and gender of school age children have inconclusive finding about the association between these two variables. Therefore, this systematic review and meta-analysis was done to determine the pooled prevalence of Schistosomiasis and its association with gender of school age children in Ethiopia. METHODS In this systematic review and meta-analysis, databases such as: Medline/PubMed, EMBASE, CINAHL, Cochrane Central library, Google Scholar, and HINARI were systematically searched. STATA version 14 was used to estimate pooled prevalence of Schistosomiasis using random effects model with 95% confidence interval. The results were presented by using forest plot and statistical heterogeneity was checked by using the Cochran Q test (chi-squared statistic), I2 test statistic and by visual examination of the forest plot. RESULTS From the total of 427 studies identified for this review, 50 studies were included in the final analysis. The analysis noted that pooled prevalence of Schistosomiasis in Ethiopia was 28.78% (95% CI: 23.81, 33.74). The subgroup analysis indicated that extreme variability was observed in the prevalence of Schistosomiasis across the regions of the country. The highest (39.77%) prevalence of Schistosomiasis was reported from the southern region, whereas the lowest (14.95%) prevalence of Schistosomiasis was reported from Afar region. Male school age children were 58% more likely infected with Schistosomiasis than female school age children in Ethiopia (OR: 1.58, 95% CI: 1.33, 1.83). CONCLUSIONS The Prevalence of Schistosomiasis was higher than the 2018 report of the Ethiopian federal ministry of health. The prevalence of Schistosomiasis was predominant among male gender of the school age children. Therefore, sustainable control of Schistosomiasis requires the approaches that must go beyond current deworming program. Complementary prevention strategies including health education, safe water and adequate sanitary facilities provision should be simultaneously implemented. The underlining causes of variation in risk factors of Schistosomiasis among males and females should be further studied.
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Affiliation(s)
- Demelash Woldeyohannes
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Biniaym Sahiledengle
- Department of Public Health, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Zeleke Hailemariam
- Department of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
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13
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Krentel A, Gyapong M, McFarland DA, Ogundahunsi O, Titaley CR, Addiss DG. Keeping communities at the centre of efforts to eliminate lymphatic filariasis: learning from the past to reach a future free of lymphatic filariasis. Int Health 2021; 13:S55-S59. [PMID: 33349882 PMCID: PMC7753171 DOI: 10.1093/inthealth/ihaa086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Since the launch of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000, more than 910 million people have received preventive chemotherapy for lymphatic filariasis (LF) and many thousands have received care for chronic manifestations of the disease. To achieve this, millions of community drug distributors (CDDs), community members and health personnel have worked together each year to ensure that at-risk communities receive preventive chemotherapy through mass drug administration (MDA). The successes of 20 y of partnership with communities is celebrated, including the application of community-directed treatment, the use of CDDs and integration with other platforms to improve community access to healthcare. Important challenges facing the GPELF moving forward towards 2030 relate to global demographic, financing and programmatic changes. New innovations in research and practice present opportunities to encourage further community partnership to achieve the elimination of LF as a public health problem. We stress the critical need for community ownership in the current Covid-19 pandemic, to counter concerns in relaunching MDA programmes for LF.
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Affiliation(s)
- Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Canada K1G 5Z3.,Bruyère Research Institute, Ottawa K1R 6M1, Canada
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences Ho, Volta Region, Ghana
| | | | | | - Christiana R Titaley
- Faculty of Medicine, Pattimura University, Maluku Province, Ambon 97233 Indonesia
| | - David G Addiss
- Focus Area for Compassion and Ethics (FACE), The Task Force for Global Health, Atlanta 30030 USA
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14
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Aruldas K, Means AR, Titus A, Jacob Y, Rajendiran R, Johnson J, Emmanuel-Fabula M, Puthupalayam Kaliappan S, Kamlakar Juvekar S, Kang G, L. Walson J, Ajjampur SSR. Gender differences in the perceived need for community-wide deworming: Formative qualitative research from the DeWorm3 study, India. PLoS Negl Trop Dis 2020; 14:e0008829. [PMID: 33237928 PMCID: PMC7688162 DOI: 10.1371/journal.pntd.0008829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
Current soil-transmitted helminth (STH) programs target morbidity control with school-based deworming. Increasing interest in steering neglected tropical disease (NTD) programmes from morbidity control towards disease elimination has prompted evaluation of strategies that may interrupt transmission. The feasibility of interrupting transmission of STH with community-wide deworming is being tested in the ongoing DeWorm3 cluster randomized trial. Gender-based perspectives about susceptibility to infection and need for treatment have been shown to influence both health-seeking behaviour and health outcomes. We carried out a qualitative study among men and women in the community to understand their knowledge, beliefs, and attitudes about STH infections and community-wide mass drug administration (cMDA). Eight semi-structured focus group discussions were conducted among men and women residing in the DeWorm3 study site in India-Vellore and Tiruvannamalai districts of Tamil Nadu. Thematic coding was used to analyse the transcripts in ATLAS.ti 8.0. Both men and women in this study demonstrated a high level of STH knowledge but some men had misconceptions that intestinal worms were beneficial. Men and women shared several similar beliefs and attitudes regarding STH treatment. Both believed that adults were likely to have STH infections and both reported that stigma prevented them from seeking treatment. Influenced by gender norms, women were more likely to associate STH infections with inadequate sanitation and hygiene, while men were more likely to believe that those engaged in agricultural work were at risk. Both genders reported a positive attitude towards cMDA for STH. Barriers to cMDA implementation differed by gender; women expressed concern regarding side-effects and drug quality while men were concerned that treatment coverage may be affected due to the absence of people during the day when the drug is distributed. Both men and women perceived the treatment of adults for STH infections to be important, however, the perceived barriers to participating in cMDA differed by gender in this community. The study identified key messages to be incorporated in communication and outreach strategies for cMDA programmes.
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Affiliation(s)
- Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Angelin Titus
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Yesudoss Jacob
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Rajeshkumar Rajendiran
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jabaselvi Johnson
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Mira Emmanuel-Fabula
- Department of Global Health, University of Washington, Seattle, United States of America
| | | | | | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Judd L. Walson
- Department of Global Health, Medicine, Pediatrics & Epidemiology, University of Washington, Seattle, United States of America
- DeWorm3, Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Sitara Swarna Rao Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
- * E-mail:
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15
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Asfaw MA, Zerdo Z, Churko C, Seife F, Yihune M, Chisha Y, Teshome A, Getachew B, Negussu N. Preventive chemotherapy coverage against soil-transmitted helminth infection among school age children: Implications from coverage validation survey in Ethiopia, 2019. PLoS One 2020; 15:e0235281. [PMID: 32589660 PMCID: PMC7319348 DOI: 10.1371/journal.pone.0235281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections remain the most common neglected tropical diseases among children living mainly in low-resource settings. Preventive chemotherapy (PC) has been implemented as one of the main public health interventions to control and eliminate STH infections. Although data on routine coverage of PC against STH are available at different level of the health system; these data are unreliable as they are subject to errors and manipulation and evidence is lacking on validated treatment coverage. Thus, this study aimed to determine anthelminthic coverage among school age children (SAC) to inform decision made in PC program implementation. METHODS We conducted a community-based cross-sectional coverage survey in ten districts of Ethiopia; in April 2019. Sample size was computed automatically using Coverage Survey Builder (CSB) tool in Microsoft excel. Thirty segments were randomly selected per each selected districts. Collected data were cleaned and analysed using SPSS software (IBM, version 25). PRINCIPAL FINDINGS In all, 8154 SAC participated in the study. The overall anthelminthic coverage was found to be 71% (95%confidence interval (CI) = 70-71.9%). The reported coverage was lower than the surveyed coverage only in Guagusa district. The PC coverage among males (71.9%) was slightly higher than females' coverage (70%); and the coverage in the age group between10 and 14 years (77%) was higher compared with the age group between 5 and 9 years (64.3%). In addition, the PC coverage in school attending children (81.1%) was much higher than coverage in non-enrolled children (28.3%). Moreover, the most frequently mentioned reasons for not swallowing drugs were drug not given (24.75%) and not attending school (19.75%). CONCUSSION This study showed that only five out of ten districts met the target threshold (minimum 75%) for effective coverage. Hence, implementations of preventive chemotherapy should be improved in those districts with low coverage data.
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Affiliation(s)
- Mekuria Asnakew Asfaw
- Collaborative Research and Training Centre for NTDs, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Zerihun Zerdo
- Collaborative Research and Training Centre for NTDs, Arba Minch University, Arba Minch, Ethiopia
| | - Chuchu Churko
- Collaborative Research and Training Centre for NTDs, Arba Minch University, Arba Minch, Ethiopia
| | - Fikre Seife
- Neglected Tropical Diseases, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Manaye Yihune
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Yilma Chisha
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abinet Teshome
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | | | - Nebiyu Negussu
- Neglected Tropical Diseases, Federal Ministry of Health, Addis Ababa, Ethiopia
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16
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Impacts of host gender on Schistosoma mansoni risk in rural Uganda-A mixed-methods approach. PLoS Negl Trop Dis 2020; 14:e0008266. [PMID: 32401770 PMCID: PMC7219705 DOI: 10.1371/journal.pntd.0008266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background The World Health Organization identified Uganda as one of the 10 highly endemic countries for schistosomiasis. Annual mass drug administration (MDA) with praziquantel has led to a decline in intensity of Schistosoma mansoni infections in several areas. However, as hotspots with high (re)infection rates remain, additional research on risk factors and implementing interventions to complement MDA are required to further reduce disease burden in these settings. Through a mixed-methods study we aimed to gain deeper understanding of how gender may impact risk and reinfection in order to inform disease control programmes and ascertain if gender-specific interventions may be beneficial. Methodology/Principal findings In Bugoto, Mayuge District, Eastern Uganda we conducted ethnographic observations (n = 16) and examined epidemiology (n = 55) and parasite population genetics (n = 16) in school-aged children (SAC), alongside a community-wide household survey (n = 130). Water contact was frequent at home, school and in the community and was of domestic, personal care, recreational, religious or commercial nature. Qualitative analysis of type of activity, duration, frequency, level of submersion and water contact sites in children showed only few behavioural differences in water contact between genders. However, survey data revealed that adult women carried out the vast majority of household tasks involving water contact. Reinfection rates (96% overall) and genetic diversity were high in boys (pre-He = 0.66; post-He = 0.67) and girls (pre-He = 0.65; post-He = 0.67), but no differences in reinfection rates (p = 0.62) or genetic diversity by gender before (p = 0.54) or after (p = 0.97) treatment were found. Conclusions/Significance This mixed methods approach showed complementary findings. Frequent water exposure with few differences between boys and girls was mirrored by high reinfection rates and genetic diversity in both genders. Disease control programmes should consider the high reinfection rates among SAC in remaining hotspots of schistosomiasis and the various purposes and settings in which children and adults are exposed to water. Globally, over 230 million people are infected with schistosomiasis, an infectious disease caused by parasitic helminths. Humans can get infected when they contact water which contains Schistosoma parasites. Although the disease can be treated with a drug, people get rapidly reinfected in certain high-transmission settings. Drug treatment alone may not be sufficient to eliminate this disease and additional interventions such as health promotion or improvements in water and sanitation need to be scaled up. To provide recommendations to these control programmes we carried out interdisciplinary research in Eastern Uganda to understand the influence of gender on schistosomiasis risk. We found that the water contact behaviour of boys and girls is quite similar, and we did not see differences in reinfection or genetic diversity of the parasite between boys and girls. Differences in water contact between genders is greater in adults, and further research is required for these individuals. In this setting, infection rates are high in school-aged children and there are no differences between genders. These results emphasise improved control efforts for all school-aged children in communities like these. Our interdisciplinary approach provided complementary findings. Such an integrated approach can therefore have more power to meaningfully inform policy on schistosomiasis control.
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Siewe Fodjo JN, Mubiru F, Ukaga C, Logora MY, Mmbando BP, Mandro M, Njamnshi AK, Colebunders R. Low ivermectin use among 5- to 6-year-old children: observations from door-to-door surveys in onchocerciasis-endemic regions in Africa. Int Health 2020; 12:72-75. [PMID: 31251354 PMCID: PMC6964214 DOI: 10.1093/inthealth/ihz044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/02/2019] [Accepted: 06/06/2019] [Indexed: 12/03/2022] Open
Abstract
During door-to-door surveys in onchocerciasis-endemic regions in Africa, the age-specific ivermectin coverage in 29 722 individuals was assessed. Children 5–6 y of age had significantly lower coverage compared with older participants. Insufficient ivermectin intake among young children could prolong onchocerciasis elimination prospects, as they may serve as human reservoirs of Onchocerca volvulus; moreover, it increases the risk of developing onchocerciasis-associated epilepsy (OAE). The causes of the low ivermectin coverage observed among children 5–6 y of age need to be explored. Integrating ivermectin distribution into chemoprophylaxis strategies for other neglected diseases could increase coverage in a cost-effective manner.
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Affiliation(s)
- J N Siewe Fodjo
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Wilrijk, Antwerp, Belgium
| | - F Mubiru
- Infectious Disease Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - C Ukaga
- Imo State University, PMB 2000, Okigwe Rd, Ugwu Orji, Owerri, Nigeria
| | - M Y Logora
- Neglected Tropical Diseases Unit, Ministry of Health, Ministry of Health Ministerial Complex, P.O. Box 88, Juba, South Sudan
| | - B P Mmbando
- National Institute for Medical Research, Tanga Center, P.O. Box 5004, Tanga, Tanzania
| | - M Mandro
- Provincial Health Division Ituri, Ministry of Health, P.O. Box 185, Bunia, Democratic Republic of Congo
| | - A K Njamnshi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon & Brain Research Africa Initiative (BRAIN), P. O. Box 87, Yaounde, Cameroon
| | - R Colebunders
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Wilrijk, Antwerp, Belgium
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Shoemaker EA, Dale K, Cohn DA, Kelly MP, Zoerhoff KL, Batcho WE, Bougouma C, Nko’Ayissi GB, Meite A, Marfo B, Goepogui A, Telfort MA, Sianipar LR, Traore M, Rimal P, Alfari DA, Anyaike C, Badiane FN, Kargbo-Labour I, Mwingira UJ, Awoussi MS, Stelmach RD, Smith CL, Arney J, Faramand TH, Stukel DM, Pou B, Rotondo LA, Kraemer JD, Baker MC. Gender and neglected tropical disease front-line workers: Data from 16 countries. PLoS One 2019; 14:e0224925. [PMID: 31856174 PMCID: PMC6922366 DOI: 10.1371/journal.pone.0224925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background Delivery of preventive chemotherapy (PC) through mass drug administration (MDA) is used to control or eliminate five of the most common neglected tropical diseases (NTDs). The success of an MDA campaign relies on the ability of drug distributors and their supervisors—the NTD front-line workers—to reach populations at risk of NTDs. In the past, our understanding of the demographics of these workers has been limited, but with increased access to sex-disaggregated data, we begin to explore the implications of gender and sex for the success of NTD front-line workers. Methodology/Principal findings We reviewed data collected by USAID-supported NTD projects from national NTD programs from fiscal years (FY) 2012–2017 to assess availability of sex-disaggregated data on the workforce. What we found was sex-disaggregated data on 2,984,908 trainees trained with financial support from the project. We then analyzed the percentage of males and females trained by job category, country, and fiscal year. During FY12, 59% of these data were disaggregated by sex, which increased to nearly 100% by FY15 and was sustained through FY17. In FY17, 43% of trainees were female, with just four countries reporting more females than males trained as drug distributors and three countries reporting more females than males trained as trainers/supervisors. Except for two countries, there were no clear trends over time in changes to the percent of females trained. Conclusions/Significance There has been a rapid increase in availability of sex-disaggregated data, but little increase in recruitment of female workers in countries included in this study. Women continue to be under-represented in the NTD workforce, and while there are often valid reasons for this distribution, we need to test this norm and better understand gender dynamics within NTD programs to increase equity.
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Affiliation(s)
| | - Kelly Dale
- WI-HER, Vienna, Virginia, United States of America
| | | | | | | | - Wilfrid E. Batcho
- National Communicable Disease Control Program, Ministry of Health, Cotonou, Republic of Benin
| | - Clarisse Bougouma
- National Neglected Tropical Disease Control Program, Disease Control Directorate, Ministry of Health, Ouagadougou, Burkina Faso
| | - Georges B. Nko’Ayissi
- Malaria and Neglected Tropical Diseases Sub-Department, Ministry of Public Health, Yaoundé, Republic of Cameroon
| | - Aboulaye Meite
- National Control Program for Preventive Chemotherapy Neglected Tropical Diseases, Ministry of Health and Public Hygiene, Abidjan, Republic of Côte d'Ivoire
| | - Benjamin Marfo
- National Neglected Tropical Diseases Program, Ghana Health Service, Accra, Republic of Ghana
| | - André Goepogui
- National Onchocerciasis and Blindness and Neglected Tropical Disease Control Program, National Prevention and Community Health Directorate, Ministry of Health, Conakry, Republic of Guinea
| | - Marc-Aurele Telfort
- National Malaria Control Program, Ministry of Public Health and Population, Port-au-Prince, Republic of Haiti
| | - Lita Renata Sianipar
- Sub-Directorate of Filariasis & Helminthiasis Control, Directorate of Vector Borne Disease Control, Directorate General of Communicable Disease and Environmental Health, Ministry of Health, Jakarta, Republic of Indonesia
| | - Mahamadou Traore
- National Schistosomiasis and Soil-Transmitted Helminths Control Program, Ministry of Health and Public Hygiene, Bamako, Mali
| | - Pradip Rimal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health, Kathmandu, Federal Democratic Republic of Nepal
| | - Djibo Aichatou Alfari
- NTD Control Program, Directorate of the Protection of Public Health, Ministry of Public Health, Niamey, Republic of Niger
| | - Chukwuma Anyaike
- Department of Public Health, Neglected Tropical Diseases Division, Federal Ministry of Health, Abuja, Federal Republic of Nigeria
| | - Fatou N. Badiane
- NTD Control Program, Disease Control Directorate, Ministry of Health and Social Work, Dakar, Senegal
| | - Ibrahim Kargbo-Labour
- Neglected Tropical Diseases Programme, Disease Prevention and Control Directorate, Ministry of Health and Sanitation, Freetown, Republic of Sierra Leone
| | - Upendo J. Mwingira
- Neglected Tropical Diseases Control Programme, Ministry of Health, Dar es Salaam, United Republic of Tanzania
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Marcel S. Awoussi
- National Neglected Tropical Disease Control Program, General Directorate of Health, Ministry of Health and Social Welfare, Lomé, Republic of Togo
| | | | - Carly L. Smith
- Office of Infectious Diseases, US Agency for International Development, Washington, DC, United States of America
| | | | | | | | - Bolivar Pou
- FHI 360, Washington, DC, United States of America
| | | | - John D. Kraemer
- RTI International, Washington, DC, United States of America
- Department of Health Systems Administration, Georgetown University, Washington, DC, United States of America
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Wharton-Smith A, Rassi C, Batisso E, Ortu G, King R, Endriyas M, Counihan H, Hamade P, Getachew D. Gender-related factors affecting health seeking for neglected tropical diseases: findings from a qualitative study in Ethiopia. PLoS Negl Trop Dis 2019; 13:e0007840. [PMID: 31830026 PMCID: PMC6907747 DOI: 10.1371/journal.pntd.0007840] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite known gender-specific differences in terms of prevalence, transmission and exposure to neglected tropical diseases (NTDs), there is limited discussion of the influence of gender in NTD programmes and interventions. There is a paucity of research on how gender interacts with NTD service provision and uptake. This study, part of broader implementation research in Ethiopia, applied a gender lens to health seeking for five NTDs: lymphatic filariasis, podoconiosis, schistosomiasis, soil-transmitted helminth infection and trachoma. METHODOLOGY/PRINCIPAL FINDINGS The study was conducted in a district of the Southern Nations, Nationalities, and Peoples' Region of Ethiopia where the five NTDs are prevalent. A qualitative methodology was adopted to explore participants' perspectives and experiences. Data generation methods included 20 interviews and four focus group discussions. Community members, volunteer Health Development Army leaders, Health Extension Workers and a range of health workers at the health post, health centre and hospital level (n = 59) were purposively sampled. Interviews and focus group discussions were audio recorded, transcribed verbatim into English then analysed through open coding, drawing on constant comparative methods. Gender related factors affected care seeking for NTDs and were described as reasons for not seeking care, delayed care seeking and treating NTDs with natural remedies. Women faced additional challenges in seeking health care due to gender inequalities and power dynamics in their domestic partnerships. Participants recommended raising community awareness about NTDs, however this remains problematic due to gender and social norms around appropriate discourse with members of the opposite gender. CONCLUSIONS/SIGNIFICANCE The findings from this study provide crucial insights into how gender interacts with accessing health services, at different levels of the health system. If we are committed to leaving no one behind and achieving universal health coverage, it is essential to address gender disparities to access and utilisation of interventions delivered by national NTD programmes.
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Affiliation(s)
| | | | | | | | - Rebecca King
- The Nuffield Centre for International Health & Development, University of Leeds, Leeds, United Kingdom
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20
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Tickell KD, Atlas HE, Walson JL. Environmental enteric dysfunction: a review of potential mechanisms, consequences and management strategies. BMC Med 2019; 17:181. [PMID: 31760941 PMCID: PMC6876067 DOI: 10.1186/s12916-019-1417-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Environmental enteric dysfunction (EED) is an acquired enteropathy of the small intestine, characterized by enteric inflammation, villus blunting and decreased crypt-to-villus ratio. EED has been associated with poor outcomes, including chronic malnutrition (stunting), wasting and reduced vaccine efficacy among children living in low-resource settings. As a result, EED may be a valuable interventional target for programs aiming to reduce childhood morbidity in low and middle-income countries. MAIN TEXT Several highly plausible mechanisms link the proposed pathophysiology underlying EED to adverse outcomes, but causal attribution of these pathways has proved challenging. We provide an overview of recent studies evaluating the causes and consequences of EED. These include studies of the role of subclinical enteric infection as a primary cause of EED, and efforts to understand how EED-associated systemic inflammation and malabsorption may result in long-term morbidity. Finally, we outline recently completed and upcoming clinical trials that test novel interventions to prevent or treat this highly prevalent condition. CONCLUSIONS Significant strides have been made in linking environmental exposure to enteric pathogens and toxins with EED, and in understanding the multifactorial mechanisms underlying this complex condition. Further insights may come from several ongoing and upcoming interventional studies trialing a variety of novel management strategies.
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Affiliation(s)
- Kirkby D Tickell
- Department of Global Health, University of Washington, 325 9th Avenue (Box 359931), Seattle, WA, 98104, USA. .,Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, F-262, Box 357236, Seattle, WA, 98195, USA. .,The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya.
| | - Hannah E Atlas
- Department of Global Health, University of Washington, 325 9th Avenue (Box 359931), Seattle, WA, 98104, USA
| | - Judd L Walson
- Department of Global Health, University of Washington, 325 9th Avenue (Box 359931), Seattle, WA, 98104, USA.,Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, F-262, Box 357236, Seattle, WA, 98195, USA.,The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya.,Department of Allergy and Infectious Disease, University of Washington, 325 9th Avenue (Box 359931), Seattle, WA, 98104, USA.,Department of Pediatrics, University of Washington, 325 9th Avenue (Box 359931), Seattle, WA, 98104, USA
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Dean L, Ozano K, Adekeye O, Dixon R, Fung EG, Gyapong M, Isiyaku S, Kollie K, Kukula V, Lar L, MacPherson E, Makia C, Kouokam Magne E, Nnamdi DB, Mue Nji T, Ntuen U, Oluwole A, Piotrowski H, Siping M, Tchoffo MN, Tchuem Tchuenté LA, Thomson R, Tsey I, Wanji S, Yashiyi J, Zawolo G, Theobald S. Neglected Tropical Diseases as a 'litmus test' for Universal Health Coverage? Understanding who is left behind and why in Mass Drug Administration: Lessons from four country contexts. PLoS Negl Trop Dis 2019; 13:e0007847. [PMID: 31751336 PMCID: PMC6871774 DOI: 10.1371/journal.pntd.0007847] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Individuals and communities affected by NTDs are often the poorest and most marginalised; ensuring a gender and equity lens is centre stage will be critical for the NTD community to reach elimination goals and inform Universal Health Coverage (UHC). NTDs amenable to preventive chemotherapy have been described as a 'litmus test' for UHC due to the high mass drug administration (MDA) coverage rates needed to be effective and their model of community engagement. However, until now highly aggregated coverage data may have masked inequities in availability, accessibility and acceptability of medicines, slowing down the equitable achievement of elimination goals. METHODS We conducted qualitative programmatic analysis across different country contexts through the novel application of the Tanahashi Coverage Framework enhanced by gendered intersectional theory to interrogate different components of programme coverage: availability, accessibility, acceptability, contact and effective. Drawing on communities and health implementers perspectives (using focus groups, interviews, and participatory methods) from varying levels of the health system, across four African country contexts (Cameroon, Ghana, Liberia and Nigeria), we show who is left behind and provide recommendations for programmes to respond. FINDINGS We have unmasked inequities in programme delivery that repeatedly leave vulnerable populations underserved in relation to the prevention and treatment of PC NTDs across all components of coverage explored within the Tanahashi framework. Inequities are influenced by health systems challenges and limitations, due to lack of consideration of gender, power and equity issues. Effective treatment for individuals and communities is shaped by individual identities and the intersecting axes of inequity that converge to shape these positions including gender, age, disability, and geography. Health systems are inherently social and gendered thus they become mediators in managing the impact that social and structural processes have on individual health outcomes. SIGNIFICANCE To our knowledge this is the only paper which has combined a comprehensive equity framework with intersectional feminist theory, to establish a fuller understanding of who is left behind and why in MDA across countries and contexts. Ensuring the most vulnerable have continued access to future treatment options will contribute to the progressive realisation of UHC, allowing the NTD community to continue to support their vision of being a true 'litmus test'.
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Affiliation(s)
- Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | | | - Ruth Dixon
- Sightsavers, Research Team, Haywards Heath, United Kingdom
| | - Ebua Gallus Fung
- COUNTDOWN, Research Foundation for Tropical Diseases and Environment, Buea, Cameroon
- COUNTDOWN, Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Buea, Cameroon
| | - Margaret Gyapong
- Institute of Health Research, University of Allied Sciences, Ho, Volta Region, Ghana
| | - Sunday Isiyaku
- Sightsavers, Nigeria Country Office, Kaduna State, Nigeria
| | - Karsor Kollie
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Vida Kukula
- Social Science Department, Dodowa Health Research Centre, Ghana Health Services, Dodowa, Ghana
| | - Luret Lar
- Sightsavers, Nigeria Country Office, Kaduna State, Nigeria
| | - Eleanor MacPherson
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | | | | | - Dum-Buo Nnamdi
- COUNTDOWN, Research Foundation for Tropical Diseases and Environment, Buea, Cameroon
- COUNTDOWN, Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Buea, Cameroon
| | - Theobald Mue Nji
- COUNTDOWN, Research Foundation for Tropical Diseases and Environment, Buea, Cameroon
- COUNTDOWN, Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Buea, Cameroon
| | - Uduak Ntuen
- Neglected Tropical Disease Programme, Federal Ministry of Health, Government of Nigeria, Abuja, Nigeria
| | | | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Marlene Siping
- Catholic University of Central Africa, Yaoundé, Cameroon
| | | | | | - Rachael Thomson
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Irene Tsey
- Institutional Review Board, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
| | - Samuel Wanji
- COUNTDOWN, Research Foundation for Tropical Diseases and Environment, Buea, Cameroon
- COUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - James Yashiyi
- Sightsavers, Nigeria Country Office, Kaduna State, Nigeria
| | - Georgina Zawolo
- University of Liberia Pacific Institute for Research and Evaluation, Monrovia, Monsterrado, Liberia
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Lo NC, Heft-Neal S, Coulibaly JT, Leonard L, Bendavid E, Addiss DG. State of deworming coverage and equity in low-income and middle-income countries using household health surveys: a spatiotemporal cross-sectional study. LANCET GLOBAL HEALTH 2019; 7:e1511-e1520. [PMID: 31558383 PMCID: PMC7024997 DOI: 10.1016/s2214-109x(19)30413-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/25/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mass deworming against soil-transmitted helminthiasis, which affects 1 billion of the poorest people globally, is one of the largest public health programmes for neglected tropical diseases, and is intended to be equitable. However, the extent to which treatment programmes for deworming achieve equitable coverage across wealth class and sex is unclear and the public health metric of national deworming coverage does not include representation of equity. This study aims to measure both coverage and equity in global, national, and subnational deworming to guide future programmatic evaluation, investment, and metric design. METHODS We used nationally representative, geospatial, household data from Demographic and Health Surveys that measured mother-reported deworming in children of preschool age (12-59 months). Deworming was defined as children having received drugs for intestinal parasites in the previous 6 months before the survey. We estimated deworming coverage disaggregated by geography, wealth quintile, and sex, and computed an equity index. We examined trends in coverage and equity index across countries, within countries, and over time. We used a regression model to compute the household correlates of deworming and ecological correlates of equitable deworming. FINDINGS Our study included 820 883 children living in 50 countries from Africa, the Americas, Asia, and Europe that are endemic for soil-transmitted helminthiasis using 77 Demographic and Health Surveys from December, 2003, to October, 2017. In these countries, the mean deworming coverage in preschool children was estimated at 33·0% (95% CI 32·9-33·1). The subnational coverage ranged from 0·5% to 87·5%, and within-country variation was greater than between-country variation. Of the 31 countries reporting that they reached the WHO goal of more than 75% national coverage, 30 had inequity in deworming, with treatment concentrated in wealthier populations. We did not detect systematic differences in deworming equity by sex. INTERPRETATION Substantial inequities in mass deworming programmes are common as wealthier populations have consistently higher coverage than that of the poor, including in countries reporting to have reached the WHO goal of more than 75% national coverage. These inequities seem to be geographically heterogeneous, modestly improving over time, with no evidence of sex differences in inequity. Future reporting of deworming coverage should consider disaggregation by geography, wealth, and sex with incorporation of an equity index to complement the conventional public health metric of national deworming coverage. FUNDING Bill & Melinda Gates Foundation, Stanford University Medical Scientist Training Program.
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Affiliation(s)
- Nathan C Lo
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA
| | - Jean T Coulibaly
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Leslie Leonard
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA
| | - Eran Bendavid
- Primary Care and Population Health, Stanford University, Stanford, CA, USA; Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - David G Addiss
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA
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