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Manca F, Ciminata G, Grieve E, Reboud J, Cooper J, McIntosh E. Cost-effectiveness of sentinel screening of endemic diseases alongside malaria diagnosis: A case study in schistosomiasis. PLoS Negl Trop Dis 2024; 18:e0012339. [PMID: 39074148 PMCID: PMC11309411 DOI: 10.1371/journal.pntd.0012339] [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: 04/19/2023] [Revised: 08/08/2024] [Accepted: 07/05/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND In countries where malaria is endemic, the use of rapid diagnostic tests(RDTs) has become routine, especially in rural settings. Such regions are characterised by often having other co-endemic infectious diseases, at high levels of prevalence. AIM To illustrate the potential added-value of "sentinel" screening for patients presenting for a routine diagnostic test for malaria, at healthcare facilities in Uganda. METHODS We developed an economic model by combining two decision trees, one for malaria and a second for the co-endemic disease schistosomiasis. The integrated model was designed to inform policy strategies for the co-endemic disease in addition to malaria (i.e., whether to test opportunistically for schistosomiasis or use mass drug administration(MDA) as per usual practice).We performed the analysis on three comparators varying testing accuracy and costs. RESULTS Sentinel screening can provide added value to the testing of patients compared with the status quo: when schistosomiasis prevalence is high then MDA is preferential; if low prevalence, treating no one is preferred. If the disease has average levels of prevalence, then a strategy involving testing is preferred. Prevalence thresholds driving the dominant strategy are dependent upon the model parameters, which are highly context specific. At average levels of prevalence for schistosomiasis and malaria for Uganda, adding a sentinel screening was cost-effective when the accuracy of test was higher than current diagnostics and when economies of scope were generated(Expected value clinical Information = 0.65$ per DALY averted, 137.91$ per correct diagnoses).Protocols using diagnostics with current accuracy levels were preferred only for levels of MDA coverage below 75%. CONCLUSION The importance of the epidemiological setting is crucial in determining the best cost-effective strategy for detecting endemic disease. Economies of scope can make sentinel screenings cost-effective strategies in specific contexts. Blanket thresholds recommended for MDA may not always be the preferred option for endemic diseases.
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Affiliation(s)
- Francesco Manca
- School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Giorgio Ciminata
- School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Eleanor Grieve
- School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Julien Reboud
- James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Jonathan Cooper
- James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Emma McIntosh
- School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Chan JTN, Nguyen V, Tran TN, Nguyen NV, Do NTT, van Doorn HR, Lewycka S. Point-of-care testing in private pharmacy and drug retail settings: a narrative review. BMC Infect Dis 2023; 23:551. [PMID: 37612636 PMCID: PMC10463283 DOI: 10.1186/s12879-023-08480-w] [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: 03/21/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Point-of-care testing (POCT) using rapid diagnostic tests for infectious disease can potentially guide appropriate use of antimicrobials, reduce antimicrobial resistance, and economise use of healthcare resources. POCT implementation in private retail settings such as pharmacies and drug shops could lessen the burden on public healthcare. We performed a narrative review on studies of POCTs in low- and middle-income countries (LMICs), and explored uptake, impact on treatment, and feasibility of implementation. METHODS We searched MEDLINE/PubMed for interventional studies on the implementation of POCT for infectious diseases performed by personnel in private retail settings. Data were extracted and analysed by two independent reviewers. RESULTS Of the 848 studies retrieved, 23 were included in the review. Studies were on malaria (19/23), malaria and pneumonia (3/23) or respiratory tract infection (1/23). Nine randomised controlled studies, four controlled, non-randomised studies, five uncontrolled interventions, one interventional pre-post study, one cross-over interventional study and three retrospective analyses of RCTs were included. Study quality was poor. Overall, studies showed that POCT can be implemented successfully, leading to improvements in appropriate treatment as measured by outcomes like adherence to treatment guidelines. Despite some concerns by health workers, customers and shop providers were welcoming of POCT implementation in private retail settings. Main themes that arose from the review included the need for well-structured training with post-training certification covering guidelines for test-negative patients, integrated waste management, community sensitization and demand generation activities, financial remuneration and pricing schemes for providers, and formal linkage to healthcare and support. CONCLUSION Our review found evidence that POCT can be implemented successfully in private retail settings in LMICs, but comprehensive protocols are needed. High-quality randomised studies are needed to understand POCTs for infectious diseases other than malaria.
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Affiliation(s)
| | - Van Nguyen
- Doctor of Medicine Programme, Duke National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Thuy Ngan Tran
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sonia Lewycka
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Martiáñez-Vendrell X, Skjefte M, Sikka R, Gupta H. Factors Affecting the Performance of HRP2-Based Malaria Rapid Diagnostic Tests. Trop Med Infect Dis 2022; 7:265. [PMID: 36288006 PMCID: PMC9611031 DOI: 10.3390/tropicalmed7100265] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
The recent COVID-19 pandemic has profoundly impacted global malaria elimination programs, resulting in a sharp increase in malaria morbidity and mortality. To reduce this impact, unmet needs in malaria diagnostics must be addressed while resuming malaria elimination activities. Rapid diagnostic tests (RDTs), the unsung hero in malaria diagnosis, work to eliminate the prevalence of Plasmodium falciparum malaria through their efficient, cost-effective, and user-friendly qualities in detecting the antigen HRP2 (histidine-rich protein 2), among other proteins. However, the testing mechanism and management of malaria with RDTs presents a variety of limitations. This paper discusses the numerous factors (including parasitic, host, and environmental) that limit the performance of RDTs. Additionally, the paper explores outside factors that can hinder RDT performance. By understanding these factors that affect the performance of HRP2-based RDTs in the field, researchers can work toward creating and implementing more effective and accurate HRP2-based diagnostic tools. Further research is required to understand the extent of these factors, as the rapidly changing interplay between parasite and host directly hinders the effectiveness of the tool.
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Affiliation(s)
- Xavier Martiáñez-Vendrell
- Molecular Virology Laboratory, Department of Medical Microbiology, LUMC Center for Infectious Diseases (LU-CID), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands or
| | - Malia Skjefte
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Ruhi Sikka
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Mathura 281406, UP, India
| | - Himanshu Gupta
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Mathura 281406, UP, India
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A Systematic Review and Meta-Analysis of Malaria Test Positivity Outcomes and Programme Interventions in Low Transmission Settings in Southern Africa, 2000-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116776. [PMID: 35682356 PMCID: PMC9180605 DOI: 10.3390/ijerph19116776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023]
Abstract
Malaria is one of the most significant causes of mortality and morbidity globally, especially in sub-Saharan Africa (SSA) countries. It harmfully disturbs the public’s health and the economic growth of many developing countries. Despite the massive effect of malaria transmission, the overall pooled proportion of malaria positivity rate in Southern Africa is still elusive. Therefore, the objective of this systematic review and meta-analysis is to pool estimates of the incidence of the malaria positivity rate, which is the first of its kind in South African countries. A literature search is performed to identify all published articles reporting the incidence of malaria positivity in Southern Africa. Out of the 3359 articles identified, 17 studies meet the inclusion for systematic review and meta-analysis. In addition, because substantial heterogeneity is expected due to the studies being extracted from the universal population, random-effects meta-analyses are carried out to pool the incidence of the malaria positivity rate from diverse diagnostic methods. The result reveals that between-study variability is high (τ2 = 0.003; heterogeneity I2 = 99.91% with heterogeneity chi-square χ2 = 18,143.95, degree of freedom = 16 and a p-value < 0.0001) with the overall random pooled incidence of 10% (95%CI: 8−13%, I2 = 99.91%) in the malaria positivity rate. According to the diagnostic method called pooled incidence estimate, the rapid diagnostic test (RDT) is the leading diagnostic method (17%, 95%CI: 11−24%, I2 = 99.95%), followed by RDT and qPCR and RDT and loop mediated isothermal amplification (LAMP), respectively, found to be (3%, 95%CI: 2−3%, I2 = 0%) and (2%, 95%CI: 1−3%, I2 = 97.94%).Findings of the present study suggest high malaria positive incidence in the region. This implies that malaria control and elimination programmes towards malaria elimination could be negatively impacted and cause delays in actualising malaria elimination set dates. Further studies consisting of larger samples and continuous evaluation of malaria control programmes are recommended.
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Effectiveness of four interventions in improving community health workers' performance in western Kenya: a quasi-experimental difference-in-differences study using a longitudinal data. Prim Health Care Res Dev 2022; 23:e20. [PMID: 35331360 PMCID: PMC8991856 DOI: 10.1017/s1463423622000135] [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] [Indexed: 11/07/2022] Open
Abstract
Background: Community health workers (CHWs) are up-front health workers delivering the most effective life-saving health services to communities. They are the key driver to achieve Universal Health Coverage. However, maintaining CHWs’ performance is one of the challenges in sustaining their effectiveness. This article assessed the effectiveness of the four interventions and their combinations on the CHWs’ performance in terms of health knowledge, job satisfaction, and household coverage. Methods: We used the longitudinal survey data collected in western Kenya. Our study participants were the representative of all CHWs working in the four districts, Kenya. The four types of interventions were composed of a basic core intervention (i.e., refresher training with/without defaulter tracing) and three supplementary interventions (i.e., provision of a bicycle, frequent supportive supervision, and financial incentives). We performed the three fixed-effect models to assess the effectiveness of the four interventions and their combinations on the three performance indicators. Results: Three single and combination interventions significantly increased CHWs’ health knowledge: refresher training only [Coef.: 48.43, 95% CI: 42.09–54.76, P < 0.001]; refresher training plus defaulter-tracing [Coef.: 38.80, 95% CI: 32.71–44.90, P < 0.001]; combination of refresher training plus defaulter-tracing and frequent supervision [Coef.: 17.02, 95% CI: 7.90–26.15, P < 0.001]. Financial support was the only intervention that significantly increased job satisfaction among CHWs [Coef.: 4.97, 95% CI: 0.20–9.75, P = 0.041]. There was no single intervention that significantly increased household coverage. Yet, the combinations of the interventions significantly increased household coverage. Conclusions: There was no single intervention to improve all the aspects of CHWs’ performance. The refresher training significantly improved their health knowledge, while financial incentive enhanced the level of their job satisfaction. The combinations of regular refresher training and other intervention(s) are the recommended as the effective interventions in improving and further sustaining CHWs’ performance.
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Stokes K, Castaldo R, Franzese M, Salvatore M, Fico G, Pokvic LG, Badnjevic A, Pecchia L. A machine learning model for supporting symptom-based referral and diagnosis of bronchitis and pneumonia in limited resource settings. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Mubanga C, Mwape KE, Phiri IK, Trevisan C, Kabululu M, Zulu G, Van Damme I, Schmidt V, Dorny P, Gabriël S. Operational characteristics of an antibody detecting point of care test for Taenia solium infections in a community and hospital setting. BMC Infect Dis 2021; 21:607. [PMID: 34172004 PMCID: PMC8235832 DOI: 10.1186/s12879-021-06320-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/09/2021] [Indexed: 01/22/2023] Open
Abstract
Background Diagnostic test evaluation includes measures of performance and assessment of operational characteristics. The latter focuses on end-user understanding of instructions to perform the test, ease of use, test turnaround time and ease of result interpretation. This study aimed to assess user comprehension of training for and ease of use of a Taenia solium point of care test (TS POC) evaluated in a community and hospital setting in Zambia and Tanzania, respectively. Methods The TS POC is a three-step in-house-produced rapid diagnostic test (RDT) for the simultaneous detection of taeniosis (TST) and cysticercosis (TSCC) antibodies. Data collected by administering questionnaires to 29 end-users and from the main evaluation database was analyzed quantitatively. Results End-users (28/29, 97%) perceived that the training they received for performing the test was sufficient. They performed 4080 tests, of which 80 were invalid. The community-based study and TST tests had higher invalid rates. The overall result interpretation was within the acceptable range of RDTs with an overall disagreement between readers of 3.3%. The Kappa coefficient of agreement was 85 and 82% for TSCC and TST, respectively. There was more disagreement among readers in the community-based study. Conclusion End-users rated the TS POC kit moderate in terms of ease of use citing long test turnaround time and difficulties in using the blood transfer device. Overall, the operational performance of the TS POC kit and end-users was within the established acceptable performance range. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06320-3.
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Affiliation(s)
- Chishimba Mubanga
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia. .,Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Kabemba E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Isaac K Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mwemezi Kabululu
- Tanzania Livestock Research Institute (TALIRI) - Uyole, P. O. Box 6191, Mbeya, Tanzania
| | - Gideon Zulu
- Provincial Health Office, Ministry of Health, Chipata, Zambia
| | - Inge Van Damme
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Veronika Schmidt
- Department of Neurology, Centre for Global Health, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Virology, Parasitology, and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Michael O, Orimadegun A, Falade C. PERSISTENCE OF PLASMODIUM FALCIPARUM HRP2 ANTIGEN AFTER EFFECTIVE ANTIMALARIAL THERAPY. Ann Ib Postgrad Med 2021; 19:15-21. [PMID: 35330886 PMCID: PMC8935674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Histidine Rich Protein 2 based (HRP2-based) malaria rapid diagnostic tests (mRDTs) have been shown to perform as well as routine light microscopy, however, they are limited by some factors including persistence of HRP2 antigenemia. In this paper we report the evaluation of an HRP2-based mRDT in a prospective study that enrolled children and followed them up for 28 days. Methods Children aged below five years, with acute episode of fever/pyrexia, were enrolled. The enrolled participants had expert malaria microscopy and RDT done at enrolment (Day 0), and on days 1, 2, 3, 7, 14, 21, and 28. The malaria RDT test was considered positive when the antigen and control lines were visible in their respective windows, negative when only the control band was visible and invalid when the control band was not visible. Faint test lines were considered positive. The RDT results were compared to those of expert microscopy. Results Two hundred and twenty-six children aged 29.2 ± 15.5 months were enrolled. The proportion of children positive by expert malaria microscopy and RDT was 100% and 95.6% respectively. During the 28 day follow up of the children the proportions positive by microscopy and RDT on days 3, 7, 14, and 28 were 1% and 94.6%, 0% and 93.5%, 0% and 91%, and 16.5% and 80.6% respectively. Gender and age dependent analysis of proportion of positive children were similar. Proportion of children with persistence of HRP2 antigen appeared to be lower in those with parasite density below 200/µL, however, this observation requires further evaluation in larger studies. Conclusion the study revealed a high proportion of persistence of HRP2 antigen in the children 28 days after effective antimalarial therapy. Histidine rich protein 2 based malaria rapid diagnostic tests are not recommended for monitoring of antimalarial therapies.
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Affiliation(s)
- O.S. Michael
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Nigeria
| | - A.E. Orimadegun
- Institute of Child Health, College of Medicine, University of Ibadan, Nigeria
| | - C.O. Falade
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Nigeria
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Dejazmach Z, Alemu G, Yimer M, Muluneh C, Tegegne B. Evaluation of the performance of health extension workers on malaria rapid diagnostic tests and predictor factors in Bahir Dar Zuria district, northwest Ethiopia: A cross-sectional study. PLoS One 2021; 16:e0249708. [PMID: 33831059 PMCID: PMC8031431 DOI: 10.1371/journal.pone.0249708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
Background In Ethiopia, anti-malaria treatment is initiated after parasitological confirmation using blood film microscopy at health centers and hospitals, or serological rapid diagnostic tests at health posts. At health posts, the diagnosis is performed by health extension workers using rapid diagnostic tests after little training. However, there is paucity of data about the health extension workers’ performance on rapid diagnostic tests. Hence, periodic monitoring of the performances of health extension workers on malaria rapid diagnostic tests and predicted factors plays a pivotal role for the control of malaria. Methods A cross sectional study was conducted in May 2020, among 75 health extension workers working at health posts in Bahir Dar Zuria district, Northwest Ethiopia. Their performance on malaria rapid diagnostic tests was assessed by distributing known positive and negative samples as confirmed by investigators using both rapid diagnostic test and blood film microscopy. Test results from health extension workers were then compared with that of investigators. Procedural errors committed while performing the tests were assessed using observational checklist. Data were analyzed using SPSS software version 20. Results The overall sensitivity and specificity of health extension workers in detecting Plasmodium species were 96.8% and 98.7%, respectively with 97.3% result agreement between the health extension workers and investigators (kappa value = 0.949). The most common procedural errors committed by health extension workers was ‘not checking expiry date of the test kits’ followed by ‘not adhering to the appropriate time of reading results’ that 70.7% and 64% of the participants committed these errors, respectively. Total number of procedural errors committed by those who have got in-service training was decreased by 47.3% as compared to those without in-service training. Conclusions Health extension workers had high performance on malaria rapid diagnostic tests. However, in-service training and periodic supervision should be given in order to maximize performance on these tests.
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Affiliation(s)
- Zelalem Dejazmach
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
- * E-mail:
| | - Getaneh Alemu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulat Yimer
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Medical Parasitology, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Chalachew Muluneh
- Medical Parasitology and Vector Control, Bahir Dar Zuria Woreda Health Office, Bahir Dar, Ethiopia
| | - Banchamlak Tegegne
- Medical Parasitology, Amhara Public Health Institute, Bahir Dar, Ethiopia
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Mutambo C, Shumba K, Hlongwana KW. Exploring the mechanism through which a child-friendly storybook addresses barriers to child-participation during HIV care in primary healthcare settings in KwaZulu-Natal, South Africa. BMC Public Health 2021; 21:508. [PMID: 33726682 PMCID: PMC7962374 DOI: 10.1186/s12889-021-10483-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background Healthcare workers (HCWs) in South Africa widely use job-aids as practical tools to enhance the provision of HIV services, thereby improving patient-provider interactions during the care process. Job-aids are visual support materials that provide appropriate information using graphics and words in a simple and yet effective manner. We explored the mechanism through the KidzAlive Talk tool storybook (Talk tool), a child-centred job-aid for HCWs that facilitates child-participation during HIV consultations in primary healthcare (PHC) clinics implementing the KidzAlive model. Methods The study was conducted in PHC clinics across four districts; namely: uMkhanyakude, Zululand, uMgungundlovu, and eThekwini in KwaZulu-Natal (KZN), South Africa. We conducted in-depth interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained and mentored HCWs (n = 20). Data were collected in both English and isiZulu languages through user-specific, structured in-depth interviews. All the interviews were audio-recorded (with participants’ assent and consent, respectively). Data were transcribed verbatim, prior to translating the isiZulu transcripts to English. Translations were done by a member of the research team competent in both languages. Electronic data were imported to NVivo 10 for analysis and subsequently analysed using a thematic analysis method followed by a constant comparative and modified grounded theory analysis method. Results The findings identified the following barriers to child-participation: Primary caregiver limiting the child’s involvement due to fear of traumatising them; HCWs’ limited knowledge and skills to deliver child-centred HIV care; childhood developmental stage-related limitations and healthcare institutional paternalism. The Talk tool addresses the above barriers by using simple language and terminology to cater for children at various stages of development; alleviating HCWs’ and PCGs’ fear of possible psychological harm to the child; using storytelling and colourful cartoon illustrations for child edutainment; Being versatile by allowing for multiple utility and tackling institutional paternalism that limit child-involvement in the process of care. Conclusions This study provided evidence on how the Talk tool storybook addresses barriers to child-participation in the HIV care process. The evidence generated from this study is compelling enough to recommend the scale-up of this innovation in low-resource settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10483-8.
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Affiliation(s)
- Chipo Mutambo
- The Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Kemist Shumba
- The Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani W Hlongwana
- The Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Dongmo Kenfack E, Tendongfor N, Nsagha DS. Home-Based Intervention for the Prevention and Treatment of Malaria Among Children Younger Than 5 Years in the West Region of Cameroon: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e19633. [PMID: 33709938 PMCID: PMC7998323 DOI: 10.2196/19633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/20/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background Although malaria is preventable and curable, 1 child dies of this disease every 2 minutes in Africa. Home-based management of malaria reduces the progression of severe malaria by more than 50%. Scalable, efficacious, and cost-effective strategies are needed to empower the capacities of home caregivers of children younger than 5 years of age in health education, diagnosis, and treatment of malaria at home. Objective The main objective of this trial is to assess the impact of the management provided by home caregivers on the prevention, diagnosis, and treatment of malaria in children younger than 5 years as compared to the home-based malaria management component of the integrated community-directed intervention (CDI) strategy of community health workers (CHWs). Methods A randomized controlled trial will be conducted. CHWs have conducted a census of all households where there is at least one child younger than 5 years with their home caregivers. These children and their home caregivers have been randomly placed into the intervention or control groups among the households identified. The trial will allow malaria home-based prevention, diagnosis, and treatment of 350 children younger than 5 years old by home caregivers in the Fombap area (intervention group) where the integrated CDI strategy will not implemented. This group will be compared to the home-based malaria management component of the integrated CDI strategy in which 350 children in the same age group will be followed up by CHWs in the Baneghang area (control group). The primary outcomes will be the prevention, diagnosis, and treatment of malaria in children younger than 5 years of age by home caregivers at home. The secondary outcomes comprise the malaria follow-up indicators produced by home caregivers in the intervention group and those produced by CHWs in the control group. Both descriptive and one-way analysis of variance estimation techniques will be used to compare the mean difference in the 2 strategies. Results From September 2019 to October 2019, all home caregivers with children younger than 5 years of age were identified in the intervention and control group by CHWs. Following this, 203 home caregivers with their 350 children younger than 5 years were randomly selected and enrolled in the intervention group, while 225 home caregivers with their 350 children younger than 5 years were enrolled in the control group. In the intervention group, 203 home caregivers were trained in November 2019. This home treatment effectively started in December 2019 and will continue until May 2020. Conclusions Findings from this randomized controlled trial will contribute to resolving the challenges of severe malaria and to limiting the death due to malaria of children younger than 5 years. This will bring benefits to home caregivers who will know how to promptly diagnose and properly treat malaria in their children at home. Trial Registration Pan African Clinical Trial Registry (PACTR) 202003487018009; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9788 International Registered Report Identifier (IRRID) DERR1-10.2196/19633
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Affiliation(s)
- Esther Dongmo Kenfack
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Nicholas Tendongfor
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Dickson Shey Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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The use of dried tube specimens of Plasmodium falciparum in an external quality assessment programme to evaluate health worker performance for malaria rapid diagnostic testing in healthcare centres in Togo. Malar J 2021; 20:50. [PMID: 33472640 PMCID: PMC7819240 DOI: 10.1186/s12936-020-03569-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of rapid diagnostic tests (RDTs) to diagnose malaria is common in sub-Saharan African laboratories, remote primary health facilities and in the community. Currently, there is a lack of reliable methods to ascertain health worker competency to accurately use RDTs in the testing and diagnosis of malaria. Dried tube specimens (DTS) have been shown to be a consistent and useful method for quality control of malaria RDTs; however, its application in National Quality Management programmes has been limited. METHODS A Plasmodium falciparum strain was grown in culture and harvested to create DTS of varying parasite density (0, 100, 200, 500 and 1000 parasites/µL). Using the dried tube specimens as quality control material, a proficiency testing (PT) programme was carried out in 80 representative health centres in Togo. Health worker competency for performing malaria RDTs was assessed using five blinded DTS samples, and the DTS were tested in the same manner as a patient sample would be tested by multiple testers per health centre. RESULTS All the DTS with 100 parasites/µl and 50% of DTS with 200 parasites/µl were classified as non-reactive during the pre-PT quality control step. Therefore, data from these parasite densities were not analysed as part of the PT dataset. PT scores across all 80 facilities and 235 testers was 100% for 0 parasites/µl, 63% for 500 parasites/µl and 93% for 1000 parasites/µl. Overall, 59% of the 80 healthcare centres that participated in the PT programme received a score of 80% or higher on a set of 0, 500 and 1000 parasites/ µl DTS samples. Sixty percent of health workers at these centres recorded correct test results for all three samples. CONCLUSIONS The use of DTS for a malaria PT programme was the first of its kind ever conducted in Togo. The ease of use and stability of the DTS illustrates that this type of samples can be considered for the assessment of staff competency. The implementation of quality management systems, refresher training and expanded PT at remote testing facilities are essential elements to improve the quality of malaria diagnosis.
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Nsobya SL, Walakira A, Namirembe E, Kiggundu M, Nankabirwa JI, Ruhamyankaka E, Arinaitwe E, Conrad MD, Kamya MR, Dorsey G, Rosenthal PJ. Deletions of pfhrp2 and pfhrp3 genes were uncommon in rapid diagnostic test-negative Plasmodium falciparum isolates from Uganda. Malar J 2021; 20:4. [PMID: 33386076 PMCID: PMC7777526 DOI: 10.1186/s12936-020-03547-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDTs) play a key role in malaria case management. The most widely used RDT identifies Plasmodium falciparum based on immunochromatographic recognition of P. falciparum histidine-rich protein 2 (PfHRP2). Deletion of the paralogous pfhrp2 and pfhrp3 genes leads to false-negative PfHRP2-based RDTs, and has been reported in P. falciparum infections from South America and Africa. However, identification of pfhrp2/pfhrp3 deletions has usually been based only on failure to amplify these genes using PCR, without confirmation based on PfHRP2 protein expression, and understanding of the true prevalence of deletions is incomplete. METHODS Deletions of pfhrp2/pfhrp3 in blood samples were investigated from cross-sectional surveys in 2012-13 in three regions of varied malaria transmission intensity in Uganda. Samples with positive Giemsa-stained thick blood smears, but negative PfHRP2-based RDTs were evaluated by PCR amplification of conserved subunit ribosomal DNA for Plasmodium species, PCR amplification of pfhrp2 and pfhrp3 genes to identify deletions, and bead-based immunoassays for expression of PfHRP2. RESULTS Of 3516 samples collected in cross-sectional surveys, 1493 (42.5%) had positive blood smears, of which 96 (6.4%) were RDT-negative. Of these 96 RDT-negative samples, P. falciparum DNA was identified by PCR in 56 (58%) and only non-falciparum plasmodial DNA in 40 (42%). In all 56 P. falciparum-positive samples there was a failure to amplify pfhrp2 or pfhrp3: in 25 (45%) pfhrp2 was not amplified, in 39 (70%) pfhrp3 was not amplified, and in 19 (34%) neither gene was amplified. For the 39 P. falciparum-positive, RDT-negative samples available for analysis of protein expression, PfHRP2 was not identified by immunoassay in only four samples (10.3%); these four samples all had failure to amplify both pfhrp2 and pfhrp3 by PCR. Thus, only four of 96 (4.2%) smear-positive, RDT-negative samples had P. falciparum infections with deletion of pfhrp2 and pfhrp3 confirmed by failure to amplify the genes by PCR and lack of expression of PfHRP2 demonstrated by immunoassay. CONCLUSION False negative RDTs were uncommon. Deletions in pfhrp2 and pfhrp3 explained some of these false negatives, but most false negatives were not due to deletion of the pfhrp2 and pfhrp3 genes.
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Affiliation(s)
- Sam L Nsobya
- Infectious Diseases Research Collaboration, Kampala, Uganda. .,Department of Pathology, College of Health Science, Makerere University Kampala, Kampala, Uganda.
| | | | | | - Moses Kiggundu
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Melissa D Conrad
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Philip J Rosenthal
- Department of Medicine, University of California, San Francisco, CA, USA
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Miller JS, Mbusa RK, Baguma S, Patel P, Matte M, Ntaro M, Bwambale S, Kenney J, Guiles D, Mulogo EM, Stone GS. Assessing Village Health Workers' Ability to Perform and Interpret Rapid Diagnostic Tests for Malaria 4 Years after Initial Training: A Cross-Sectional Study. Am J Trop Med Hyg 2020; 104:294-297. [PMID: 33146114 DOI: 10.4269/ajtmh.20-0747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Village health workers (VHWs) in Bugoye subcounty, Uganda, provide integrated community case management (iCCM) care to children younger than 5 years for malaria, pneumonia, and diarrhea. We assessed the longevity of VHWs' skills in performing and reading malaria rapid diagnostic tests (RDTs) 4 years after initial training, comparing VHWs who had completed initial iCCM training 1 year before the study with VHWs who had completed training 4 years before the study. Both groups received quarterly refresher trainings. Trained interviewers observed 36 VHWs reading six mock RDTs each and performing an RDT as part of a larger skills assessment exercise. VHWs read 97% of mock RDTs correctly; of the 36 VHWs, 86% read all six mock RDTs correctly. Most VHWs scored either 12/13 or 13/13 on the RDT checklist (39% and 36%, respectively), with 25% scoring 11/13 or lower. For reading mock RDTs, VHWs in the first group (initial training 4 years before study) read 97% of mock RDTs correctly, whereas those in the second group (initial training 1 year before study) read 96% of mock RDTs correctly; the first group had a mean of 5.83 RDTs read correctly, compared with 5.77 RDTs read correctly in the second group (P = 0.83). For performing an RDT, the first group completed a mean of 12.0 steps correctly, compared with a mean of 12.2 correct steps in the second group (P = 0.60). Overall, VHWs demonstrated proficiency in reading RDTs accurately and performing RDTs according to protocol at least 4 years after initial iCCM training.
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Affiliation(s)
- James S Miller
- 1Massachusetts General Hospital, Boston, Massachusetts.,2Harvard Medical School, Boston, Massachusetts.,3Global Health Collaborative, Mbarara, Uganda
| | | | | | - Palka Patel
- 4Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Moses Ntaro
- 3Global Health Collaborative, Mbarara, Uganda.,5Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Jessica Kenney
- 1Massachusetts General Hospital, Boston, Massachusetts.,3Global Health Collaborative, Mbarara, Uganda
| | - Daniel Guiles
- 7Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Edgar Mugema Mulogo
- 3Global Health Collaborative, Mbarara, Uganda.,5Mbarara University of Science and Technology, Mbarara, Uganda
| | - Geren S Stone
- 1Massachusetts General Hospital, Boston, Massachusetts.,2Harvard Medical School, Boston, Massachusetts.,3Global Health Collaborative, Mbarara, Uganda
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Carcelen AC, Hayford K, Moss WJ, Book C, Thuma PE, Mwansa FD, Patenaude B. How much does it cost to measure immunity? A costing analysis of a measles and rubella serosurvey in southern Zambia. PLoS One 2020; 15:e0240734. [PMID: 33057405 PMCID: PMC7561102 DOI: 10.1371/journal.pone.0240734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/01/2020] [Indexed: 12/03/2022] Open
Abstract
Background Serosurveys are a valuable surveillance tool because they provide a more direct measure of population immunity to infectious diseases, such as measles and rubella, than vaccination coverage estimates. However, there is concern that serological surveys are costly. We adapted a framework to capture the costs associated with conducting a serosurvey in Zambia. Methods We costed a nested serosurvey in Southern Province, Zambia that collected dried blood spots from household residents in a post-campaign vaccine coverage survey. The financial costs were estimated using an ingredients-based costing approach. Inputs included personnel, transportation, field consumable items, social mobilization, laboratory supplies, and capital items, and were classified by serosurvey function (survey preparation, data collection, biospecimen collection, laboratory testing, and coordination). Inputs were stratified by whether they were applicable to surveys in general or attributable specifically to serosurveys. Finally, we calculated the average cost per cluster and participant. Results We estimated the total nested serosurvey cost was US $68,558 to collect dried blood spots from 658 participants in one province in Zambia. A breakdown of the cost by serosurvey phase showed data collection accounted for almost one third of the total serosurvey cost (32%), followed by survey preparation (25%) and biospecimen collection (20%). Analysis by input categories indicated personnel costs were the largest contributing input to overall serosurvey costs (51%), transportation was second (23%), and field consumables were third (9%). By combining the serosurvey with a vaccination coverage survey, there was a savings of $43,957. We estimated it cost $4,285 per average cluster and $104 per average participant sampled. Conclusions Adding serological specimen collection to a planned vaccination coverage survey provided a more direct measurement of population immunity among a wide age group but increased the cost by approximately one-third. Future serosurveys could consider ways to leverage existing surveys conducted for other purposes to minimize costs.
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Affiliation(s)
- Andrea C. Carcelen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - Bryan Patenaude
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Needs SH, Bull SP, Bravo J, Walker S, Little G, Hart J, Edwards AD. Remote videolink observation of model home sampling and home testing devices to simplify usability studies for point-of-care diagnostics. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16105.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Both home sample collection and home testing using rapid point-of-care diagnostic devices can offer benefits over attending a clinic/hospital to be tested by a healthcare professional. Usability is critical to ensure that in-home sampling or testing by untrained users does not compromise analytical performance. Usability studies can be laborious and rely on participants attending a research location or a researcher visiting homes; neither has been appropriate during COVID-19 outbreak control restrictions. We therefore developed a remote research usability methodology using videolink observation of home users. This avoids infection risks from home visits and ensures the participant follows the test protocol in their home environment. In this feasibility study, volunteers were provided with models of home blood testing and home blood sampling kits including a model lancet, sampling devices for dried blood spot collection, and model lateral flow device. After refining the study protocol through an initial pilot (n = 7), we compared instructions provided either as written instructions (n = 5), vs addition of video instructions (n = 5), vs written and video instructions plus videolink supervision by the researcher (n = 5). All users were observed via video call to define which test elements could be assessed remotely. All 22 participants in the study accessed the video call and configured their videolink allowing the researcher to clearly observe all testing tasks. The video call allowed the researcher to assess distinct errors during use including quantitative (volume of blood) and qualitative (inaccurate interpretation of results) errors many of which could compromise test accuracy. All participants completed the tasks and returned images of their completed tests (22/22) and most returned completed questionnaires (20/22). We suggest this remote observation via videolink methodology is a simple, rapid and powerful methodology to assess and optimise usability of point-of-care testing methods in the home setting.
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Incardona S, Bell D, Campillo A, Cunningham J, Ariey F, Fandeur T, Luchavez J, Luna CA, Ménard D, Nhem S, Sornillo JB, Witkowski B, Katz Z, Dittrich S, Ding XC. Keep the quality high: the benefits of lot testing for the quality control of malaria rapid diagnostic tests. Malar J 2020; 19:247. [PMID: 32660630 PMCID: PMC7359453 DOI: 10.1186/s12936-020-03324-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background The production and use of malaria rapid diagnostic tests (RDTs) has risen dramatically over the past 20 years. In view of weak or non-existing in vitro diagnostics (IVD) regulations and post-marketing surveillance (PMS) systems in malaria endemic countries, the World Health Organization, later joined by the Foundation for Innovative New Diagnostics, established an independent, centralized performance evaluation and Lot Testing (LT) programme to safeguard against poor quality of RDTs being distributed through the public health sector of malaria endemic countries. RDT performances and manufacturer quality management systems have evolved over the past decade raising questions about the future need for a centralized LT programme. Results Between 2007 and 2017, 6056 lots have been evaluated, representing approximately 1.6 Billion RDTs. A total of 69 lots (1.1%) failed the quality control. Of these failures, 26 were detected at receipt of the RDT lot in the LT laboratory, representing an estimated 7.9 million poor quality RDTs, and LT requesters were advised that RDTs were not of sufficient quality for use in patient management. Forty-three were detected after long-term storage in the laboratory, of which 24 (56%) were found to be due to a major issue with insufficient buffer volume in single use buffer vials, others predominantly showing loss of sensitivity. The annual cost of running the programme, based on expenses recorded in years 2014–2016, an estimated volume of 700 lots per year and including replenishment of quality control samples, was estimated at US$ 178,500 ($US 255 per lot tested). Conclusions Despite the clear benefits of the centralized LT programme and its low cost compared with the potential costs of each country establishing its own PMS system for RDTs, funding concerns have made its future beyond 2020 uncertain. In order to manage the risks of misdiagnosis due to low quality RDTs, and to ensure the continued safety and reliability of malaria case management, there is a need to ensure that an effective and implementable approach to RDT quality control continues to be available to programmes in endemic countries.
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Affiliation(s)
| | - David Bell
- Independent consultant, Issaquah, WA, USA
| | | | - Jane Cunningham
- World Health Organization/Global Malaria Programme (WHO/GMP), Geneva, Switzerland
| | - Frederic Ariey
- Hôpital Cochin, Laboratoire de Parasitologie-Mycologie, INSERM U1016 (Institut Cochin), Université de Paris, Paris, France
| | - Thierry Fandeur
- Direction Internationale, Institut Pasteur de Paris, Paris, France
| | - Jennifer Luchavez
- Parasitology Department, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Christian Anthony Luna
- Parasitology Department, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Didier Ménard
- Malaria Genetics and Resistance Unit, Parasites and Insect Vectors Department, Institut Pasteur, Paris, France
| | - Sina Nhem
- National Center for Entomology, Parasitology and Malaria Control, Phnom Penh, Cambodia
| | - Johanna Beulah Sornillo
- Epidemiology and Biostatistics Department, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Benoit Witkowski
- Laboratoire d'Epidémiologie Moléculaire du Paludisme, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Sabine Dittrich
- FIND, Geneva, Switzerland.,Nuffield School of Medicine, University of Oxford, Oxford, UK
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Evaluating the implementation of rapid diagnostic tests in a malaria elimination setting. Infect Dis Poverty 2020; 9:84. [PMID: 32641123 PMCID: PMC7346650 DOI: 10.1186/s40249-020-00702-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022] Open
Abstract
Background It was recommended that malaria rapid diagnostic tests (RDTs) should be available in all epidemiological situations. But evidence was limited on the implementation of RDTs and its effectiveness in malaria elimination settings. This study examined the implementation of RDTs and how it affected the diagnosis of imported malaria patients in Jiangsu Province, China. Methods To scale up RDTs, this study developed an intervention package with four major elements covering the supply of RDT test, the training on RDTs, the monitoring and management of RDT use, and the advocacy of RDTs. By using a pretest-posttest control group design, we implemented the interventions in 4 cities in Jiangsu Province with the rest nine cities as controlled areas, from January 2017 to January 2018. Difference-in-Difference approach was used to evaluate the impact of the scale-up of RDTs on the identification of malaria cases. Three binary outcome measures were included to indicate delayed malaria diagnosis, malaria cases with confirmed malaria diagnosis at township-level institutions, and severe malaria cases, respectively. Linear probability regression was performed with time and group fixed effects and the interaction term between time and group. Results Intervention areas received sufficient RDT test supply, regular professional training programs, monthly tracking and management of RDT supply and use, and health education to targeted population. The implementation of interventions was associated with 10.8% (P = 0.021) fewer patients with delayed diagnosis. But intervention areas did not see a higher likelihood of having confirmed diagnosis from township-level institutions (coefficient = -0.038, P = 0.185) or reduced severe malaria cases (coef. = 0.040, P = 0.592). Conclusions The comprehensive package of RDT implementation in this study is promising in scaling up RDT use and improving access to care among malaria patients, especially in malaria elimination settings.
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Análisis de concordancia de tres pruebas para el diagnóstico de malaria en la población sintomática de los municipios endémicos de Colombia. BIOMÉDICA 2020; 40:117-128. [PMID: 32220168 PMCID: PMC7357380 DOI: 10.7705/biomedica.4893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Indexed: 11/30/2022]
Abstract
Introducción. Dadas las dificultades del diagnóstico microscópico de la malaria o paludismo en las áreas rurales, las pruebas de diagnóstico rápido constituyen una buena alternativa, por lo que es importante conocer su desempeño. Objetivo. Evaluar el desempeño de las pruebas de diagnóstico rápido utilizadas en cinco departamentos para al diagnóstico microscópico de la malaria usando la reacción en cadena de la polimerasa (PCR) como estándar de referencia. Materiales y métodos. Se usaron la prueba de gota gruesa y las pruebas de diagnóstico rápido y, además, se impregnó papel de filtro con sangre para la prueba molecular (PCR), en individuos sintomáticos. Resultados. Se incluyeron 314 muestras cuyo porcentaje de positividad para malaria fue de 49 % con la PCR, de 48 % con microscopía y de 46 % con las pruebas de diagnóstico rápido; la parasitemia fluctuó entre 180 y 23.800 parásitos/pl de sangre. La concordancia de los resultados de los puestos de microscopía comparados con la PCR (Laboratorio Nacional de Referencia) fueron los siguientes: coeficiente kappa de Cohen de 0,975 (IC95% 0,950-0,999), sensibilidad de 97 % (IC95% 95-100) y especificidad de 100 % (IC95% 100-100), e índice kappa de especie de 0,958 (IC95% 0,912-1,00). La concordancia de los resultados de la prueba de diagnóstico rápido Pf/Pv en los puestos de microscopía y los de la PCR (Laboratorio Nacional de Referencia), fue la siguiente: coeficiente kappa de 0,878 (IC95% 0,784-0,973), sensibilidad de 94 % (IC95% 87-100), especificidad de 95 % (IC95% 90-100), e índice kappa de especie de 1,0 (IC95% 1,00-1,00). La concordancia entre la prueba de diagnóstico rápido Pf/Pan y la PCR fue la siguiente: coeficiente kappa de Cohen de 0,920 (IC95% 0,865-0,974), sensibilidad de 94 % (IC95% 90-98), especificidad de 99 % (IC95% 95-100), e índice kappa de especie de 0,750 (IC95% 0,637-0,863). Conclusión. Los resultados de este estudio respaldan el uso de las pruebas de diagnóstico rápido en Colombia, aunque se requiere un mejor entrenamiento del personal para diferenciar eficientemente las especies de Plasmodium.
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Prah JK, Yeboah-Sarpong A, Pinkrah R, Ewudzi-Acquah E. Assessment of the knowledge, attitude and practices of prescribers regarding malaria diagnosis: a cross sectional study among Ghanaian prescribers. Pan Afr Med J 2019; 34:207. [PMID: 32180881 PMCID: PMC7060909 DOI: 10.11604/pamj.2019.34.207.19940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/05/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Malaria has proven to be the most fatal parasitic disease known to man. Among the pillars to malaria control are early and accurate diagnosis. In 2010, the World Health Organization launched its test, treat and track initiative which seeks to ensure that all suspected cases of malaria are tested. However, after several years of implementation, the use of malaria tests in diagnosing malaria has not been optimum. This study was conducted to assess the level of knowledge of prescribers on malaria Rapid Diagnostic Test and microscopy and to determine factors influencing prescribers' decision to request and use malaria tests in practice. Methods A cross sectional study was carried out among 100 prescribers of various categories working in 4 hospitals in Ghana in March 2019. A pre-tested self-administered questionnaire was used to collect information on knowledge, malaria diagnostic practices and challenges faced by prescribers regarding parasitological testing for malaria in their health facilities. Results Overall, 73% of respondents had good knowledge on malaria diagnostics. Routine use of malaria tests in diagnosing malaria was reported as 84%. Only 9% reported complete reliance on test results. Most participants (90%) reported awareness of the test-based case management of malaria. Conclusion This study demonstrated that even though there was a high level of awareness of the test-before treatment policy among prescribers, significant numbers did not routinely request a malaria test for all suspected cases of malaria. Factors cited as barriers by prescribers were both health worker and health-system related that are all potentially modifiable.
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Cunningham J, Jones S, Gatton ML, Barnwell JW, Cheng Q, Chiodini PL, Glenn J, Incardona S, Kosack C, Luchavez J, Menard D, Nhem S, Oyibo W, Rees-Channer RR, Gonzalez I, Bell D. A review of the WHO malaria rapid diagnostic test product testing programme (2008-2018): performance, procurement and policy. Malar J 2019; 18:387. [PMID: 31791354 PMCID: PMC6889598 DOI: 10.1186/s12936-019-3028-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
Malaria rapid diagnostic tests (RDTs) emerged in the early 1990s into largely unregulated markets, and uncertain field performance was a major concern for the acceptance of tests for malaria case management. This, combined with the need to guide procurement decisions of UN agencies and WHO Member States, led to the creation of an independent, internationally coordinated RDT evaluation programme aiming to provide comparative performance data of commercially available RDTs. Products were assessed against Plasmodium falciparum and Plasmodium vivax samples diluted to two densities, along with malaria-negative samples from healthy individuals, and from people with immunological abnormalities or non-malarial infections. Three measures were established as indicators of performance, (i) panel detection score (PDS) determined against low density panels prepared from P. falciparum and P. vivax wild-type samples, (ii) false positive rate, and (iii) invalid rate, and minimum criteria defined. Over eight rounds of the programme, 332 products were tested. Between Rounds 1 and 8, substantial improvements were seen in all performance measures. The number of products meeting all criteria increased from 26.8% (11/41) in Round 1, to 79.4% (27/34) in Round 8. While products submitted to further evaluation rounds under compulsory re-testing did not show improvement, those voluntarily resubmitted showed significant increases in P. falciparum (p = 0.002) and P. vivax PDS (p < 0.001), with more products meeting the criteria upon re-testing. Through this programme, the differentiation of products based on comparative performance, combined with policy changes has been influential in the acceptance of malaria RDTs as a case-management tool, enabling a policy of parasite-based diagnosis prior to treatment. Publication of product testing results has produced a transparent market allowing users and procurers to clearly identify appropriate products for their situation, and could form a model for introduction of other, broad-scale diagnostics.
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Affiliation(s)
- Jane Cunningham
- World Health Organization (WHO), Global Malaria Programme, 20 Appia Avenue, 1211, Geneva, Switzerland.
| | - Sophie Jones
- Independent Consultant, Bedford Hill, Balham, London, SW12 9HR, UK.,Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Bldg. 23, Room 10-169, 1600 Clifton Road, Mailstop D-67, Atlanta, GA, 30329, USA
| | - Michelle L Gatton
- School of Public Health and Social Work, Queensland University of Technology (QUT), 2 George St, Brisbane, QLD, Australia
| | - John W Barnwell
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, 30329, USA
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute (ADFMIDI), Gallipoli Barracks Enoggera, 4051, Brisbane, Australia
| | - Peter L Chiodini
- Department of Clinical Parasitology, Hospital for Tropical Diseases (HTD), Mortimer Market Centre, Mortimer Market, Capper St, Fitzrovia, London, UK.,London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Jeffrey Glenn
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Bldg. 23, Room 10-169, 1600 Clifton Road, Mailstop D-67, Atlanta, GA, 30329, USA
| | - Sandra Incardona
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Building B, Level 0, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Cara Kosack
- Médecins Sans Frontières (MSF), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - Jennifer Luchavez
- Parasitology Department of the Research Institute of Tropical Medicine (RITM), 9002 Research Dr, Alabang, Muntinlupa, The Philippines
| | - Didier Menard
- Laboratoire d'Epidémiologie Moléculaire du Paludisme, Institut Pasteur du Cambodge, Monivong Boulevard, PO 983, Phnom Penh, Cambodia
| | - Sina Nhem
- Laboratoire d'Epidémiologie Moléculaire du Paludisme, Institut Pasteur du Cambodge, Monivong Boulevard, PO 983, Phnom Penh, Cambodia
| | - Wellington Oyibo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos (UL), Private Mail Bag 12003, Lagos, Nigeria
| | - Roxanne R Rees-Channer
- Department of Clinical Parasitology, Hospital for Tropical Diseases (HTD), Mortimer Market Centre, Mortimer Market, Capper St, Fitzrovia, London, UK.,Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Building B, Level 0, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Iveth Gonzalez
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Building B, Level 0, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - David Bell
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Building B, Level 0, Chemin des Mines 9, 1202, Geneva, Switzerland
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Paz-Soldan VA, Morrison AC, Sopheab H, Schwarz J, Bauer KM, Mckenney JL, Chhea C, Saphonn V, Khuon D, Hontz RD, Gorbach PM. Potential Use of Community-Based Rapid Diagnostic Tests for Febrile Illnesses: Formative Research in Peru and Cambodia. PLoS Negl Trop Dis 2019; 13:e0007773. [PMID: 31658252 PMCID: PMC6837536 DOI: 10.1371/journal.pntd.0007773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 11/07/2019] [Accepted: 09/11/2019] [Indexed: 12/04/2022] Open
Abstract
In 2012, the U.S. Defense Threat Reduction Agency Joint Science and Technology Office initiated a program to develop novel point-of-need diagnostic devices for surveillance of emerging infectious diseases including dengue, malaria, plague, and melioidosis. Prior to distribution of devices to observe their correct use among community members in Iquitos, Peru, and Phnom Penh, Cambodia, research was conducted to: 1) assess acceptability of use, including the motivation to use a rapid diagnostic test (RDT) before or instead of seeking care at a health facility, 2) explore comprehension of RDT use instructions, and 3) examine possible strategies for large scale RDT distribution and use at each site. In February 2014, 9 focus group discussions (FGD) with community members and 5 FGD with health professionals were conducted in Iquitos, and 9 FGD with community members and 9 in-depth interviews with health professionals in Phnom Penh. In both places, participants agreed to use the device themselves (involving finger prick) or could identify someone who could do so in their home or neighborhood. The main incentive to RDT use in both sites was the ability for device results to be used for care facilitation (post confirmatory tests), specifically reduced wait times to be seen or obtain a diagnosis. Comprehension of RDT use instructions was assessed in Iquitos by asking some participants to apply the device to research team members; after watching a short video, most steps were done correctly. In Phnom Penh, participants were asked to describe each step after reading the instructions; they struggled with comprehension. Health professionals’ main concerns in both sites were their community’s ability to accurately use the test, handle complicated instructions, and safety (i.e., disposal of lancets). Health system structure and ability to use home diagnostic devices varied in the two disease endemic sites, with substantial challenges in each, suggesting the need for different strategies for RDT large scale community use, and illustrating the value of formative research before deployment of novel technologies. Development and use of devices to diagnose infectious diseases outside of health facilities (i.e., at home or in remote areas) continues to increase, providing new options for the follow up and treatment options of individuals, depending on the diseases. In this qualitative study, researchers in Iquitos, Peru, and Phnom Penh, Cambodia explored what local people thought about the possible availability of such a device to diagnose dengue and malaria in their own houses, and what would motivate them to use such a device instead of going directly to a health facility for the diagnosis. Participants reported being willing to use device on themselves and were motivated by the possibility that, by using this diagnostic device and taking the result to their health facility, they might be able to obtain quicker and more optimized attention at the health facility; for example, by obtaining a positive result to dengue or malaria on the rapid diagnostic device, they are aware they might still need confirmatory tests, but they would be able to reduce the wait time for obtaining a definitive diagnosis and starting treatment by a full day. Questions regarding accuracy of tests, complicated instructions and safety of using these devices in the community were brought up by participants—individuals living in the communities and local health professionals. Also, in this study, it was clear that if these devices were to be made available in Peru and Cambodia, different strategies for disseminating and using these in the communities would be needed to accommodate for different health infrastructure in both sites.
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Affiliation(s)
- Valerie A. Paz-Soldan
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
- Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Amy C. Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
- U.S. Naval Medical Research Unit—6 (NAMRU-6), Lima, Peru
| | - Heng Sopheab
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Julia Schwarz
- Icahn School of Medicine at Mt Sinai, New York, New York, United States of America
| | - Karin M. Bauer
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
- University of Washington, Seattle, Washington, United States of America
| | - Jennie L. Mckenney
- University of California Fielding School of Public Health, Los Angeles, California, United States of America
| | - Chhorvann Chhea
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Dyna Khuon
- University of Health Sciences, Phnom Penh, Cambodia
| | - Robert D. Hontz
- U.S. Naval Medical Research Unit—6 (NAMRU-6), Lima, Peru
- Naval Medical Research Center, Fort Detrick, Maryland, United States of America
| | - Pamina M. Gorbach
- University of California Fielding School of Public Health, Los Angeles, California, United States of America
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23
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Langston A, Wittcoff A, Ngoy P, O'Keefe J, Kozuki N, Taylor H, Barbera Lainez Y, Bacary S. Testing a simplified tool and training package to improve integrated Community Case Management in Tanganyika Province, Democratic Republic of Congo: a quasi-experimental study. J Glob Health 2019; 9:010810. [PMID: 31263553 PMCID: PMC6594717 DOI: 10.7189/jogh.09.010810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Integrated community case management (iCCM) is a strategy to train community health workers (relais communautaires or RECOs in French) in low-resource settings to provide treatment for uncomplicated malaria, pneumonia, and diarrhea for children 2-59 months of age. The package of Ministry of Public Health tools for RECOs in the Democratic Republic of Congo that was being used in 2013 included seven data collection tools and job aids which were redundant and difficult to use. As part of the WHO-supported iCCM program, the International Rescue Committee developed and evaluated a simplified set of pictorial tools and curriculum adapted for low-literate RECOs. Methods The revised training curriculum and tools were tested in a quasi-experimental study, with 74 RECOs enrolled in the control group and 78 RECOs in the intervention group. Three outcomes were assessed during the study period from Sept. 2015-July 2016: 1) quality of care, measured by direct observation and reexamination; 2) workload, measured as the time required for each assessment – including documentation; and 3) costs of rolling out each package. Logistic regression was used to calculate odds ratios for correct treatment by the intervention group compared to the control group, controlling for characteristics of the RECOs, the child, and the catchment area. Results Children seen by the RECOs in the intervention group had nearly three times higher odds of receiving correct treatment (adjusted odds ratio aOR = 2.9, 95% confidence interval CI = 1.3-6.3, P = 0.010). On average, the time spent by the intervention group was 10.6 minutes less (95% CI = 6.6-14.7, P < 0.001), representing 6.2 hours of time saved per month for a RECO seeing 35 children. The estimated cost savings amounts to over US$ 300 000 for a four-year program supporting 1500 RECOs. Conclusion This study demonstrates that, at scale, simplified tools and a training package adapted for low-literate RECOs could substantially improve health outcomes for under-five children while reducing implementation costs and decreasing their workload. The training curriculum and simplified tools have been adopted nationally based on the results from this study.
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Affiliation(s)
- Anne Langston
- International Rescue Committee, New York, New York, USA
| | | | - Pascal Ngoy
- International Rescue Committee, Kinshasa, DR Congo
| | | | - Naoko Kozuki
- International Rescue Committee, New York, New York, USA
| | - Hannah Taylor
- International Rescue Committee, New York, New York, USA
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Kotepui KU, Kotepui M, Punsawad C. Knowledge, Attitude, and Practice Related to Malaria Diagnosis among Healthcare Workers in Hospitals: A Cross-Sectional Survey. J Trop Med 2019; 2019:1414079. [PMID: 31285744 PMCID: PMC6594246 DOI: 10.1155/2019/1414079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/01/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022] Open
Abstract
Malaria is a potential medical emergency and should be treated immediately because delays in diagnosis and treatment are the leading causes of death in many countries. This study aimed to assess the knowledge, attitude, and practice related to malaria diagnosis for early detection among healthcare workers in the laboratories of hospitals in Thailand. The design of the study was a descriptive cross-sectional study carried out between January 2016 and March 2017 at 11 hospitals in Thailand. The interviewees included any scientists who were currently working in a medical laboratory. Mean scores for knowledge, attitude, and practice for each healthcare group were calculated and compared between groups. Data analysis was performed using the SPSS version 11.5 software package (SPSS Inc., Chicago, IL, USA). Among a total of 118 healthcare workers, most of the healthcare workers had fair to good knowledge, attitude, and practice related to malaria detection. Among the various positions of healthcare workers, medical technologists possessed a greater knowledge on malaria detection than medical technician assistants or laboratory assistants (X2 = 9.822, d.f. = 2, and P value=0.007). This study infers that knowledge, attitude, and practice related to malaria detection among healthcare workers in laboratories were adequate. However, some points of knowledge and practice must be updated. There is a very urgent need to update knowledge on malaria, especially about the number of Plasmodium species causing relapse in malaria patients. In addition, there is an urgent need to update the practice related to malaria detection, especially about the staining process for early detection of malaria.
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Affiliation(s)
- Kwuntida Uthaisar Kotepui
- Medical Technology Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Manas Kotepui
- Medical Technology Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Chuchard Punsawad
- School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand
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Eliades MJ, Wun J, Burnett SM, Alombah F, Amoo-Sakyi F, Chirambo P, Tesha G, Davis KM, Hamilton P. Effect of Supportive Supervision on Performance of Malaria Rapid Diagnostic Tests in Sub-Saharan Africa. Am J Trop Med Hyg 2019; 100:876-881. [PMID: 30793697 PMCID: PMC6447133 DOI: 10.4269/ajtmh.18-0364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/12/2018] [Indexed: 11/07/2022] Open
Abstract
Rapid diagnostic tests (RDTs) are one of the primary tools used for parasitological confirmation of suspected cases of malaria. To ensure accurate results, health-care workers (HCWs) must conduct the RDT test correctly. Trained supervisors visited 3,603 facilities to assess RDT testing performance and conduct outreach training and supportive supervision activities in eight African countries between 2015 and 2017, using a 12-point checklist to determine if key steps were being performed. The proportion of HCWs performing each step correctly improved between 1.1 and 21.0 percentage points between the first and third visits. Health-care worker scores were averaged to calculate facility scores, which were found to be high: the average score across all facilities was 85% during the first visit and increased to 91% during the third visit. A regression analysis of these facility scores estimated that, holding key facility factors equal, facility performance improved by 5.3 percentage points from the first to the second visit (P < 0.001), but performance improved only by 0.6 percentage points (P = 0.10) between the second and third visits. Factors strongly associated with higher scores included the presence of a laboratory worker at the facility and the presence of at least one staff member with previous formal training in malaria RDTs. Findings confirm that a comprehensive quality assurance system of training and supportive supervision consistently, and often significantly, improves RDT performance.
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Affiliation(s)
- M. James Eliades
- Malaria, Asia: Population Services International, Yangon, Myanmar
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
- Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | - Jolene Wun
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Sarah M. Burnett
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Fozo Alombah
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Felicia Amoo-Sakyi
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Accra, Ghana
| | - Petros Chirambo
- President’s Malaria Initiative (PMI) MalariaCare Project, Medical Care Development International, Lilongwe, Malawi
| | - Goodluck Tesha
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Dar es Salaam, Tanzania
| | - Kelly M. Davis
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Paul Hamilton
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
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Effects of a job aid-supported intervention during antenatal care visit in rural Tanzania. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2018.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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REASSURED diagnostics to inform disease control strategies, strengthen health systems and improve patient outcomes. Nat Microbiol 2018; 4:46-54. [PMID: 30546093 PMCID: PMC7097043 DOI: 10.1038/s41564-018-0295-3] [Citation(s) in RCA: 412] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/18/2018] [Indexed: 01/27/2023]
Abstract
Lack of access to quality diagnostics remains a major contributor to health burden in resource-limited settings. It has been more than 10 years since ASSURED (affordable, sensitive, specific, user-friendly, rapid, equipment-free, delivered) was coined to describe the ideal test to meet the needs of the developing world. Since its initial publication, technological innovations have led to the development of diagnostics that address the ASSURED criteria, but challenges remain. From this perspective, we assess factors contributing to the success and failure of ASSURED diagnostics, lessons learnt in the implementation of ASSURED tests over the past decade, and highlight additional conditions that should be considered in addressing point-of-care needs. With rapid advances in digital technology and mobile health (m-health), future diagnostics should incorporate these elements to give us REASSURED diagnostic systems that can inform disease control strategies in real-time, strengthen the efficiency of health care systems and improve patient outcomes.
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28
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Goshu M, Godefay H, Bihonegn F, Ayalew F, Haileselassie D, Kebede A, Temam G, Gidey G. Assessing the competence of midwives to provide care during labor, childbirth and the immediate postpartum period - A cross sectional study in Tigray region, Ethiopia. PLoS One 2018; 13:e0206414. [PMID: 30379970 PMCID: PMC6209306 DOI: 10.1371/journal.pone.0206414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 10/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background The availability of a skilled birth attendant is widely recognized as a critical factor in reducing maternal and newborn mortality. Competence of maternal healthcare providers directly affects quality of care and health outcomes. This study assessed competence of midwives and associated factors in provision of care during labor, and the immediate postpartum period at public health facilities in Tigray, Ethiopia. Methods A cross-sectional study design was employed to collect data through direct observation of the performance of 144 midwives selected from 57 health facilities. Data were collected from January to February 2015 by 12 experienced midwives who were trained on basic emergency obstetric care and had previous experience with data collection. Using a standardized competence checklist, adapted from International confederation of midwives, data collectors interviewed and directly observed the performance of midwives from admission of laboring mothers to six hours after delivery. Multivariable linear regression was used to identify predicators associated with overall clinical competence of midwives. Result The mean competence score of midwives was found to be 51%. In multivariable linear regression, male midwifery professionals (p = 0.022), availability of up to date job aids in work place (p = 0.04) and being recognized for improved performance (p = 0.005) were significantly associated with competence of midwives in the provision of care during labor, childbirth and immediate postpartum period. Conclusion Competence of midwives was found to be low to provide safe and quality maternity care in the region. Male gender, availability of complete job aids and receiving recognition/awards for better performance were predicted competence. This requires attention and investment from Tigray regional health bureau and health development partners working on maternal and child health. Competence based in-service training, on-the-job mentoring, availing up to dated standard job aids, recognition of high performing midwives are recommended to improve the quality of maternity care in public health facilities of the region. Moreover, affirmative actions including on-the-job training and supervision are needed to improve the competence of female midwives.
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Affiliation(s)
| | | | | | | | | | | | | | - Gebreamlak Gidey
- Department of Midwifery, College of Health Sciences, Aksum University, Aksum, Ethiopia
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Pati P, Dhangadamajhi G, Bal M, Ranjit M. High proportions of pfhrp2 gene deletion and performance of HRP2-based rapid diagnostic test in Plasmodium falciparum field isolates of Odisha. Malar J 2018; 17:394. [PMID: 30373573 PMCID: PMC6206925 DOI: 10.1186/s12936-018-2502-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/03/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND With the documentation of cases of falciparum malaria negative by rapid diagnostic tests (RDT), though at low frequency from natural isolates in a small pocket of Odisha, it became absolutely necessary to investigate the status of HRP-2 based RDT throughout the state and in different seasons of the year. METHODS Suspected individuals were screened for malaria infection by microscopy and RDT in 25/30 districts of Odisha, India. Discrepancies in results were confirmed by PCR. False negative RDT samples for Plasmodium falciparum mono-infection were evaluated for detection of HRP2 antigen in ELISA and genotyped for pfhrp2, pfhrp3 and their flanking genes. Multiplicity of infection was ascertained based on msp1 and msp2 genotyping and parasitaemia level was determined by microscopy. RESULTS Of the total 1058 patients suspected for malaria, 384 were microscopically confirmed for P. falciparum mono-infection and RDT failure was observed in 58 samples at varying proportion in different regions of the state. The failure in detection was due to undetectable level of HRP-2. Although most of these samples were screened during rainy season (45/345), significantly high proportion (9/17) of RDT negative samples were obtained during the summer compared to rainy season (P = 0.0002; OR = 7.5). PCR genotyping of pfhrp2 and pfhrp3 in RDT negative samples showed 38/58 (65.5) samples to be pfhrp2 negative and 24/58 (41.4) to be pfhrp3 negative including dual negative in 17/58 (29.3). Most of the RDT negative samples (39/58) were with single genotype infection and high proportions of pfhrp2 deletion (7/9) was observed in summer. No difference in parasitaemia level was observed between RDT positive and RDT negative patients. CONCLUSION High prevalence of parasites with pfhrp2 deletion including dual deletions (pfhrp2 and pfhrp3) is a serious cause of concern, as these patients could not be given a correct diagnosis and treatment. Therefore, HRP2-based RDT for diagnosing P. falciparum infection in Odisha is non-reliable and must be performed in addition to or replaced by other appropriate diagnostic tools for clinical management of the disease.
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Affiliation(s)
- Pallabi Pati
- Molecular Epidemiology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | | | - Madhusmita Bal
- Immunology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | - Manoranjan Ranjit
- Molecular Epidemiology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India.
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Kitutu FE, Wamani H, Selling KE, Katabazi FA, Kuteesa RB, Peterson S, Kalyango JN, Mårtensson A. Can malaria rapid diagnostic tests by drug sellers under field conditions classify children 5 years old or less with or without Plasmodium falciparum malaria? Comparison with nested PCR analysis. Malar J 2018; 17:365. [PMID: 30326926 PMCID: PMC6192306 DOI: 10.1186/s12936-018-2508-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/06/2018] [Indexed: 01/02/2023] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) available as dipsticks or strips, are simple to perform, easily interpretable and do not require electricity nor infrastructural investment. Correct interpretation of and compliance with the RDT results is a challenge to drug sellers. Thus, drug seller interpretation of RDT strips was compared with laboratory scientist re-reading, and PCR analysis of Plasmodium DNA extracted from RDT nitrocellulose strips and fast transient analysis (FTA) cards. Malaria RDT cassettes were also assessed as a potential source of Plasmodium DNA. Methods A total of 212 children aged between 2 and 60 months, 199 of whom had complete records at two study drug shops in south western Uganda participated in the study. Duplicate 5 μL samples of capillary blood were picked from the 212 children, dispensed onto the sample well of the CareStart™ Pf-HRP2 RDT cassette and a FTA, Whatman™ 3MM filter paper in parallel. The RDT strip was interpreted by the drug seller within 15–20 min, visually re-read centrally by laboratory scientist and from it; Plasmodium DNA was recovered and detected by PCR, and compared with FTA recovered P. falciparum DNA PCR detection. Results Malaria positive samples were 62/199 (31.2%, 95% CI 24.9, 38.3) by drug seller interpretation of RDT strip, 59/212 (27.8%, 95% CI 22.2, 34.3) by laboratory scientist, 55/212 (25.9%, 95% CI 20.0, 32.6) by RDT nitrocellulose strip PCR and 64/212 (30.2%, 95% CI 24.4, 37.7). The overall agreement between the drug seller interpretation and laboratory scientist re-reading of the RDT strip was 93.0% with kappa value of 0.84 (95% CI 0.75, 0.92). The drug seller compliance with the reported RDT results was 92.5%. The performance of the three diagnostic strategies compared with FTA-PCR as the gold standard had sensitivity between 76.6 and 86.9%, specificity above 90%, positive predictive values ranging from 79.0 to 89.8% and negative predictive values above 90%. Conclusion Drug sellers can use RDTs in field conditions and achieve acceptable accuracy for malaria diagnosis, and they comply with the RDT results. Plasmodium DNA can be recovered from RDT nitrocellulose strips even in the context of drug shops. Future malaria surveillance and diagnostic quality control studies with RDT cassette as a source of Plasmodium DNA are recommended. Electronic supplementary material The online version of this article (10.1186/s12936-018-2508-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Freddy Eric Kitutu
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden. .,Pharmacy Department, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Henry Wamani
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Katarina Ekholm Selling
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Fred Ashaba Katabazi
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Bisaso Kuteesa
- Infectious Disease Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stefan Peterson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.,UNICEF, Health Section, 3 UN Plaza, New York, NY, 10017, USA
| | - Joan Nakayaga Kalyango
- Pharmacy Department, Makerere University College of Health Sciences, Kampala, Uganda.,Clinical Epidemiology and Biostatistics Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
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Boakye MDS, Owek CJ, Oluoch E, Wachira J, Afrane YA. Challenges of achieving sustainable community health services for community case management of malaria. BMC Public Health 2018; 18:1150. [PMID: 30285684 PMCID: PMC6167894 DOI: 10.1186/s12889-018-6040-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/16/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Community Case Management of malaria (CCMm) using Community Health Workers (CHWs) is an approach to improve access to timely and effective malaria case management in malaria endemic countries. So far the programme has been shown to be effective in many communities in sub-Saharan Africa. However, questions remain on the sustainability of this programme due to the high dropout cases of CHWs given their modest remuneration. The aim of the study was to identify challenges of achieving sustainable community health services for CCMm. METHODS A community based qualitative study was conducted in five districts in western Kenya where CCMm was being undertaken. In-depth interviews and focus group discussions were conducted with the CHWs, mothers of children under-five years and key informants such as public health officers and clinicians involved in the CCMm. The interviews were audio recorded and conducted in English, Swahili and the local language. Recorded interviews were transcribed. Analysis was conducted using NVivo version 7 software, where transcripts were coded after which themes related to the objectives of the study were identified. RESULTS The community members, the CHWs and stakeholders perceived CCMm as an important approach for reducing the burden of malaria. Key informants perceived lack of basic supplies (RDTs, gloves), drugs, inadequate remuneration of CHWs and lack of basic working equipment as challenges for CCM. CHWs highlighted that lack of drugs and basic supplies such as gloves at the health facilities, inadequate community sensitization by health workers, inadequate stipend to meet basic needs, as challenges of achieving sustainable CCMm. Some clinicians perceived that CHWs should not be given Artemisinin-based combination therapy (ACT) as part of the CCMm since they might misuse them. CONCLUSION This study shows that for CCMm to be sustainable, concerted efforts from stakeholders are needed to boost the programme. Commodities needed for implementation of the programme need to be readily available and the morale of the CHWs who undertake CCMm needs boosting.
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Affiliation(s)
- Michelle D S Boakye
- Department of Nursing, School of Medicine and Health Science, Central University, Tema, Ghana
| | - Collins J Owek
- Kenya Red Cross Society, Global Fund Programme Management Unit, Nairobi, Kenya
| | | | - Juddy Wachira
- Department of Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Yaw A Afrane
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana.
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Osorio L, Garcia JA, Parra LG, Garcia V, Torres L, Degroote S, Ridde V. A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas. Infect Dis Poverty 2018; 7:87. [PMID: 30173662 PMCID: PMC6120097 DOI: 10.1186/s40249-018-0474-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/01/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings. There is a need to know what rapid diagnostic technologies are available, have been properly assessed, and are being implemented to improve control of these diseases in the urban context. This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty. MAIN BODY A scoping review was conducted. Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases, diagnostics evaluations, rapid tests, and urban setting. The review was limited to studies published between 2000 and 2016 in English, Spanish, French, and Portuguese. Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography. A total of 179 documents of the 7806 initially screened were included in the analysis. Malaria (n = 100) and tuberculosis (n = 47) accounted for the majority of studies that reported diagnostics performance, impact, and implementation outcomes. Fewer studies, assessing mainly performance, were identified for visceral leishmaniasis (n = 9), filariasis and leptospirosis (each n = 5), enteric fever and schistosomiasis (each n = 3), dengue and leprosy (each n = 2), and Chagas disease, human African trypanosomiasis, and cholera (each n = 1). Reported sensitivity of rapid tests was variable depending on several factors. Overall, specificities were high (> 80%), except for schistosomiasis and cholera. Impact and implementation outcomes, mainly acceptability and cost, followed by adoption, feasibility, and sustainability of rapid tests are being evaluated in the field. Challenges to implementing rapid tests range from cultural to technical and administrative issues. CONCLUSIONS Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection. However, most evidence comes from malaria rapid diagnostics, with variable results. While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies, more evidence on performance of current tests or development of new alternatives is needed for dengue, Chagas disease, filariasis, leptospirosis, enteric fever, human African trypanosomiasis, schistosomiasis and cholera.
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Affiliation(s)
- Lyda Osorio
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
| | - Jonny Alejandro Garcia
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
- School of Medicine, Universidad del Valle, Cali, Colombia
| | - Luis Gabriel Parra
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
- School of Medicine, Universidad del Valle, Cali, Colombia
| | - Victor Garcia
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
| | - Laura Torres
- Epidemiology and Population Health Research Group, School of Public Health, Universidad del Valle, Calle 4B No. 36-00 Edif 118 Escuela de Salud Pública, Universidad del Valle Campus San Fernando, Cali, Colombia
| | - Stéphanie Degroote
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Valéry Ridde
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
- French Institute for Research on Sustainable Development (IRD), Paris Descartes University, Population and Development Center (CEPED), Université Paris Sorbonne Cité, National Institute of Health and Medical Research (INSERM), Health, Vulnerabilities and Gender Relations South (SAGESUD), Paris, France
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Vernelen K, Barbé B, Gillet P, Van Esbroeck M, China B, Jacobs J. Photo-based External Quality Assessment of Malaria rapid diagnostic tests in a non-endemic setting. PLoS One 2018; 13:e0201622. [PMID: 30169508 PMCID: PMC6118386 DOI: 10.1371/journal.pone.0201622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction In non-endemic settings, expertise in malaria microscopy is limited and rapid diagnostic tests (RDTs) are an adjunct to malaria diagnosis. Aim We performed an External Quality Assessment (EQA) on reading and interpretation of malaria RDTs in a non-endemic setting. Methods Participants were medical laboratories in Belgium and the Grand Duchy of Luxembourg using malaria RDTs; they received (i) 10 high-resolution photographs presenting test line combinations of RDTs with interpretations listed in a multiple choice format and (ii) a questionnaire about their practices of malaria diagnosis. Results Among 135 subscribing laboratories, 134 (99.3%) used 139 RDT products (11 different products from 8 brands). After exclusion of the results of one laboratory, analysis was done for 133 laboratories using 137 RDT products. Scores of 10/10, 9/10 and 8/10 were achieved for 58.4%, 13.1% and 8.0% of 137 RDT products respectively. For three-band P. falciparum–pan-Plasmodium RDTs (113 (82.5%) products, 6 brands), most frequent errors were (1) disregarding faint test lines (18.6%), (2) reporting invalid instead of P. falciparum (16.8%) and (3) reporting “Plasmodium spp., no further differentiation possible” without mentioning the presence or absence of P. falciparum (11.5%). For four-band RDTs (21 (15.3%) products, 1 brand), errors were (4) disregarding faint P. vivax test lines (47.6%) and (5) reporting “Plasmodium spp., no further differentiation possible” without mentioning the presence of P. falciparum and P. vivax (28.6%). Instructions for use (IFU) of only 4 out of 10 RDT products mentioned to interpret faint-intensity test lines as positive (conducive to errors 1 and 4) and IFU of 2 products displayed incorrect information (conducive to errors 2 and 5). Outside of office hours, 36.1% of participants relied on RDTs as the initial diagnostic test; 13.9% did not perform microscopic confirmation. Conclusion Reading and interpretation of malaria RDTs was satisfactory, but errors were embedded in the instructions for use of the products. Relying on RDTs alone for malaria diagnosis (about one third of participants) is not a recommended practice.
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Affiliation(s)
- Kris Vernelen
- Quality of Medical Laboratories, Institute of Public Health, Sciensano, Brussels, Belgium
- * E-mail:
| | | | | | | | - Bernard China
- Quality of Medical Laboratories, Institute of Public Health, Sciensano, Brussels, Belgium
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
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Rapid design and fielding of four diagnostic technologies in Sierra Leone, Thailand, Peru, and Australia: Successes and challenges faced introducing these biosensors. SENSING AND BIO-SENSING RESEARCH 2018. [DOI: 10.1016/j.sbsr.2018.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Allan-Blitz LT, Vargas SK, Konda KA, Herbst de Cortina S, Cáceres CF, Klausner JD. Field evaluation of a smartphone-based electronic reader of rapid dual HIV and syphilis point-of-care immunoassays. Sex Transm Infect 2018; 94:589-593. [PMID: 30126946 DOI: 10.1136/sextrans-2017-053511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/14/2018] [Accepted: 07/20/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Electronic (E) devices read and quantify lateral flow-based rapid tests, providing a novel approach to assay interpretation. We evaluated the performance of one E-reader for two dual HIV and syphilis immunoassays. METHODS We enrolled men who have sex with men and transgender women >18 years of age seeking medical services at an STD clinic in Lima, Peru, between October 2016 and April 2017. Venous blood was tested using two dual HIV and syphilis antibody immunoassays (SD BIOLINE HIV/Syphilis Duo, Republic of Korea, and First Response HIV 1+2/Syphilis Combo, India). Reference testing included a fourth-generation ELISA for HIV antibodies and use of the Treponema pallidum particle agglutination assay for syphilis antibodies. Trained clinic staff visually inspected the immunoassay results, after which the immunoassays were read by the HRDR-200 E-reader (Cellmic, USA), an optomechanical smartphone attachment. We calculated the concordance of the E-reader with visual inspection, as well as the sensitivity of both rapid immunoassays, in detecting HIV and T. pallidum antibodies. RESULTS On reference testing of 283 participant specimens, 34% had HIV antibodies and 46% had T. pallidum antibodies. Using First Response, the concordance of the E-reader with visual inspection was 97% (95% CI 94% to 99%) for T . pallidum and 97% (95% CI 95% to 99%) for HIV antibodies. Using SD BIOLINE, the concordance of the E-reader with visual inspection was 97% (95% CI 94% to 99%) for T. pallidum and 99% (95% CI 98% to 99%) for HIV antibodies. For both immunoassays, the sensitivity for HIV antibodies was 98% (95% CI 93% to 100%) and the sensitivity for T. pallidum antibodies was 81% (95% CI 73% to 87%). CONCLUSIONS E-reader results correlated well with visual inspection. The sensitivities of both rapid assays were comparable with past reports. Further evaluation of the E-reader is warranted to investigate its utility in data collection, monitoring and documentation of immunoassay results.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Silver K Vargas
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelika A Konda
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sasha Herbst de Cortina
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Carlos F Cáceres
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jeffrey D Klausner
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
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Incardona S, Kyabayinze DJ, Bell D, Ndawula B, Kanyago MC, Mwancha-Kwasa MC, González IJ. Accuracy, Ease of Use, Safety, and Acceptability of a 23-μL Conical Cup Blood Transfer Device for Use with Rapid Diagnostic Tests. Am J Trop Med Hyg 2018; 99:797-804. [PMID: 30014818 PMCID: PMC6169173 DOI: 10.4269/ajtmh.17-0716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Devices to safely transfer fixed amounts of finger prick blood to rapid diagnostic tests (RDTs) pose a significant challenge, especially in non-laboratory settings. Following the success of an “inverted cup device” for transfer of 5 μL blood, a prototype with a conical cup shape was developed for transfer of 20 μL blood, the amount needed for human immunodeficiency virus or human African trypanosomiasis (HAT) RDTs. This study determined the volume of blood transferred by this new blood transfer device (BTD) and compared its ease of use, safety, and acceptability with that of a plastic pipette when used by health workers (HWs) for HAT RDTs in northwestern Uganda. After a half-day training, 48 HWs had used the two BTDs with at least 10 patients. The conical cup BTD effectively transferred a mean of 22.76 μL of blood (standard deviation 3.31 μL). A significantly higher proportion of HWs were able to collect the full amount of blood using the conical cup BTD, as compared with the pipette (92.4% versus 74.2%, P < 0.001). In HW questionnaires, the conical cup BTD scored higher than the pipette in various aspects of ease of use and safety. In addition, HWs preferred the conical cup BTD (79%), indicating that it was easy to handle, made work faster, and increased their confidence in front of the patient. These findings suggest that the design of the conical cup BTD may be adapted for RDTs requiring 20 μL of blood to facilitate safe and accurate blood transfer.
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Affiliation(s)
- Sandra Incardona
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | | | - David Bell
- Intellectual Ventures, Global Good Fund, Bellevue, Washington
| | - Bbale Ndawula
- School of Biomedical Science, Makerere University, Kampala, Uganda
| | | | | | - Iveth J González
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Harvey SA. Observe Before You Leap: Why Observation Provides Critical Insights for Formative Research and Intervention Design That You'll Never Get From Focus Groups, Interviews, or KAP Surveys. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:299-316. [PMID: 29794000 PMCID: PMC6024634 DOI: 10.9745/ghsp-d-17-00328] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 02/06/2018] [Indexed: 12/12/2022]
Abstract
Four case studies show how observation can uncover issues critical to making a health intervention succeed or, sometimes, reveal reasons why it is likely to fail. Observation can be particularly valuable for interventions that depend on mechanical or clinical skills; service delivery processes; effects of the built environment; and habitual tasks that practitioners find difficult to articulate. Formative research is essential to designing both study instruments and interventions in global health. While formative research may employ many qualitative methods, focus group discussions and in-depth interviews are the most common. Observation is less common but can generate insights unlikely to emerge from any other method. This article presents 4 case studies in which observation revealed critical insights: corralling domestic poultry to reduce childhood diarrhea, promoting insecticide-treated bed nets (ITNs) to prevent malaria, evaluating skilled birth attendant competency to manage life-threatening obstetric and neonatal complications, and assessing community health worker (CHW) ability to use malaria rapid diagnostic tests (RDTs). Observation of Zambian CHWs to design malaria RDT training materials revealed a need for training on how to take finger-stick blood samples, a procedure second nature to many health workers but one that few CHWs had ever performed. In Lima, Peru, study participants reported keeping their birds corralled “all the time,” but observers frequently found them loose, a difference potentially explained by an alternative interpretation of the phrase “all the time” to mean “all the time (except at some specific seemingly obvious times).” In the Peruvian Amazon, observation revealed a potential limitation of bed net efficacy due to the built environment: In houses constructed on stilts, many people sleep directly on the floor, allowing mosquitoes to bite from below through gaps in the floorboards. Observation forms and checklists from each case study are included as supplemental files; these may serve as models for designing new observation guides. The case studies illustrate the value of observation to clearly understanding clinical practices and skills, details about how people carry out certain tasks, routine behaviors people would most likely not think to describe in an interview, and environmental barriers that must be overcome if an intervention is to succeed. Observation provides a way to triangulate for social desirability bias and to measure details that interview or focus group participants are unlikely to recognize, remember, or be able to describe with precision.
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Affiliation(s)
- Steven A Harvey
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Okeyo ILA, Dowse R. An illustrated booklet for reinforcing community health worker knowledge of tuberculosis and facilitating patient counselling. Afr J Prim Health Care Fam Med 2018; 10:e1-e7. [PMID: 29943595 PMCID: PMC6018457 DOI: 10.4102/phcfm.v10i1.1687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 11/15/2022] Open
Abstract
Background Community health workers (CHWs) have facilitated the move to decentralise tuberculosis (TB) management, but lack access to information appropriate both for personal use and in patient interaction and education. Aim To explore the impact of a pictorial-based TB booklet on reinforcing CHW knowledge and facilitating patient counselling. Setting This study was conducted in local primary health care clinics and the Hospice in Grahamstown, Eastern Cape Province in South Africa. Methods Quantitative and qualitative methods were used. A simple, 17-page, A5 booklet containing pictograms and simple text was designed in collaboration with CHWs who advised on preferred content. Its influence on knowledge was assessed in 31 CHWs using a 17-item questionnaire in a before-and-after study. The experiences of CHWs using the booklet were qualitatively explored using focus group discussions (FGD) and semi-structured interviews. Results Overall knowledge increased significantly from 70.6% to 85.3% (p < 0.001) with 8 of 17 questions significantly better answered at follow-up. These addressed meaning of side effects and side effect advice for patients, cause and prevention of TB, action if a dose is forgotten, timing of dose in relation to food intake and the possibility that not all patients are cured. Community health workers reported using the booklet during patient interactions, commenting that it enhanced their confidence in their own TB-related knowledge, improved recall of information and reduced uncertainty. They appreciated the simplicity of the text and its user-friendliness because of the inclusion of pictograms. The booklet was perceived to be valuable as a tool for both patient education as well as improved communication with patients. Conclusion A simple, user-friendly TB booklet containing pictograms improved CHW knowledge and acted as a valuable tool in patient communication and education.
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Affiliation(s)
- Ida L A Okeyo
- Faculty of Pharmacy, Rhodes University, South Africa; School of Public Health, University of Western Cape.
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Boyce MR, Menya D, Turner EL, Laktabai J, Prudhomme-O'Meara W. Evaluation of malaria rapid diagnostic test (RDT) use by community health workers: a longitudinal study in western Kenya. Malar J 2018; 17:206. [PMID: 29776359 PMCID: PMC5960182 DOI: 10.1186/s12936-018-2358-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/15/2018] [Indexed: 12/26/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) are a simple, point-of-care technology that can improve the diagnosis and subsequent treatment of malaria. They are an increasingly common diagnostic tool, but concerns remain about their use by community health workers (CHWs). These concerns regard the long-term trends relating to infection prevention measures, the interpretation of test results and adherence to treatment protocols. This study assessed whether CHWs maintained their competency at conducting RDTs over a 12-month timeframe, and if this competency varied with specific CHW characteristics. Methods From June to September, 2015, CHWs (n = 271) were trained to conduct RDTs using a 3-day validated curriculum and a baseline assessment was completed. Between June and August, 2016, CHWs (n = 105) were randomly selected and recruited for follow-up assessments using a 20-step checklist that classified steps as relating to safety, accuracy, and treatment; 103 CHWs participated in follow-up assessments. Poisson regressions were used to test for associations between error count data at follow-up and Poisson regression models fit using generalized estimating equations were used to compare data across time-points. Results At both baseline and follow-up observations, at least 80% of CHWs correctly completed 17 of the 20 steps. CHWs being 50 years of age or older was associated with increased total errors and safety errors at baseline and follow-up. At follow-up, prior experience conducting RDTs was associated with fewer errors. Performance, as it related to the correct completion of all checklist steps and safety steps, did not decline over the 12 months and performance of accuracy steps improved (mean error ratio: 0.51; 95% CI 0.40–0.63). Visual interpretation of RDT results yielded a CHW sensitivity of 92.0% and a specificity of 97.3% when compared to interpretation by the research team. None of the characteristics investigated was found to be significantly associated with RDT interpretation. Conclusions With training, most CHWs performing RDTs maintain diagnostic testing competency over at least 12 months. CHWs generally perform RDTs safely and accurately interpret results. Younger age and prior experiences with RDTs were associated with better testing performance. Future research should investigate the mode by which CHW characteristics impact RDT procedures. Electronic supplementary material The online version of this article (10.1186/s12936-018-2358-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew R Boyce
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Diana Menya
- Department of Epidemiology and Biostatistics, Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jeremiah Laktabai
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Wendy Prudhomme-O'Meara
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Epidemiology and Biostatistics, Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya.,Duke University Medical Center, Durham, NC, USA
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Poyer S, Musuva A, Njoki N, Okara R, Cutherell A, Sievers D, Lussiana C, Memusi D, Kiptui R, Ejersa W, Dolan S, Charman N. Fever case management at private health facilities and private pharmacies on the Kenyan coast: analysis of data from two rounds of client exit interviews and mystery client visits. Malar J 2018. [PMID: 29534750 PMCID: PMC5850910 DOI: 10.1186/s12936-018-2267-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Private sector availability and use of malaria rapid diagnostic tests (RDTs) lags behind the public sector in Kenya. Increasing channels through which quality malaria diagnostic services are available can improve access to testing and help meet the target of universal diagnostic testing. Registered pharmacies are currently not permitted to perform blood tests, and evidence of whether malaria RDTs can be used by non-laboratory private providers in line with the national malaria control guidelines is required to inform ongoing policy discussions in Kenya. Methods Two rounds of descriptive cross-sectional exit interviews and mystery client surveys were conducted at private health facilities and registered pharmacies in 2014 and 2015, 6 and 18 months into a multi-country project to prime the private sector market for the introduction of RDTs. Data were collected on reported RDT use, medicines received and prescribed, and case management of malaria test-negative mystery clients. Analysis compared outcomes at facilities and pharmacies independently for the two survey rounds. Results Across two rounds, 534 and 633 clients (including patients) from 130 and 120 outlets were interviewed, and 214 and 250 mystery client visits were completed. Reported testing by any malaria diagnostic test was higher in private health facilities than registered pharmacies in both rounds (2014: 85.6% vs. 60.8%, p < 0.001; 2015: 85.3% vs. 56.3%, p < 0.001). In registered pharmacies, testing by RDT was 52.1% in 2014 and 56.3% in 2015. At least 75% of test-positive patients received artemisinin-based combination therapy (ACT) in both rounds, with no significant difference between outlet types in either round. Provision of any anti-malarial for test-negative patients ranged from 0 to 13.9% across outlet types and rounds. In 2015, mystery clients received the correct (negative) diagnosis and did not receive an anti-malarial in 75.5% of visits to private health facilities and in 78.4% of visits to registered pharmacies. Conclusions Non-laboratory staff working in registered pharmacies in Kenya can follow national guidelines for diagnosis with RDTs when provided with the same level of training and supervision as private health facility staff. Performance and compliance to treatment recommendations are comparable to diagnostic testing outcomes recorded in private health facilities.
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Affiliation(s)
| | | | | | - Robi Okara
- Population Services International, Nairobi, Kenya
| | | | - Dana Sievers
- Population Services International, Washington, DC, USA
| | | | - Dorothy Memusi
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
| | - Rebecca Kiptui
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
| | - Waqo Ejersa
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
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Goudge J, Chirwa T, Eldridge S, Gómez-Olivé FXF, Kabudula C, Limbani F, Musenge E, Thorogood M. Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa. BMJ Glob Health 2018. [PMID: 29527345 PMCID: PMC5841534 DOI: 10.1136/bmjgh-2017-000577] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction In low/middle-income countries with substantial HIV and tuberculosis epidemics, health services often neglect other highly prevalent chronic conditions, such as hypertension, which as a result are poorly managed. This paper reports on a study to assess the effect on hypertension management of lay health workers (LHW) working in South African rural primary healthcare clinics to support the provision of integrated chronic care. Methods A pragmatic cluster randomised trial with a process evaluation in eight rural clinics assessed the effect of adding two LHWs supporting nurses in providing chronic disease care in each intervention clinic over 18 months. Control clinics continued with usual care. The main outcome measure was the change in the difference of percentage of clinic users who had elevated cardiovascular risk associated with high blood pressure (BP) before and after the intervention, as measured by two cross-sectional population surveys. Results There was no improvement in BP control among users of intervention clinics as compared with control clinics. However, the LHWs improved clinic functioning, including overall attendance, and attendance on the correct day. All clinics faced numerous challenges, including rapidly increasing number of users of chronic care, unreliable BP machines and cuffs, intermittent drug shortages and insufficient space. Conclusion LHWs improved the process of providing care but improved BP control required improved clinical care by nurses which was compromised by large and increasing numbers of patients, the dominance of the vertically funded HIV programme and the poor standards of equipment in clinics. Trial registration number ISRCTN12128227.
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Affiliation(s)
- Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Francesc Xavier F Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Limbani
- Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret Thorogood
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Incardona S, Mwancha-Kwasa M, Rees-Channer RR, Albertini A, Havumaki J, Chiodini P, Oyibo W, Gonzalez IJ. The inverted cup device for blood transfer on malaria RDTs: ease of use, acceptability and safety in routine use by health workers in Nigeria. Malar J 2018; 17:29. [PMID: 29334955 PMCID: PMC5769227 DOI: 10.1186/s12936-018-2173-0] [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: 03/17/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria rapid diagnostic tests (RDTs) are becoming widely adopted for case management at community level. However, reports and anecdotal observations indicate that the blood transfer step poses a significant challenge to many users. This study sought to evaluate the inverted cup device in the hands of health workers in everyday clinical practice, in comparison with the plastic pipette, and to determine the volume accuracy of the device made of a lower-cost plastic. METHODS The volume accuracy of inverted cup devices made of two plastics, PMMA and SBC, was compared by transferring blood 150 times onto filter paper and comparing the blood spot areas with those produced by 20 reference transfers with a calibrated micropipette. The ease of use, safety and acceptability of the inverted cup device and the pipette were evaluated by 50 health workers in Nigeria. Observations were recorded on pre-designed questionnaires, by the health workers themselves and by trained observers. Focus group discussions were also conducted. RESULTS The volume accuracy assessment showed that the device made from the low-cost material (SBC) delivered a more accurate volume (mean 5.4 μL, SD 0.48 μL, range 4.5-7.0 μL) than the PMMA device (mean 5.9 μL, SD 0.48 μL, range 4.9-7.2 μL). The observational evaluation demonstrated that the inverted cup device performed better than the pipette in all aspects, e.g. higher proportions of health workers achieved successful blood collection (96%, vs. 66%), transfer of the required blood volume (90%, vs. 58%), and blood deposit without any loss (95%, vs. 50%). Majority of health workers also considered it' very easy' to use (81%),'very appropriate' for everyday use (78%), and 50% of them reported that it was their preferred BTD. CONCLUSIONS The good volume accuracy and high acceptability of the inverted cup device shown in this study, along with observed ease of use and safety in hands of health workers, further strengthens prior findings which demonstrated its higher accuracy as compared with other BTDs in a laboratory setting. Altogether, these studies suggest that the inverted cup device should replace other types of devices for use in day-to-day malaria diagnosis with RDTs.
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Affiliation(s)
- Sandra Incardona
- Foundation for Innovative New Diagnostics, 9 Chemin des Mines, 1202, Geneva, Switzerland.
| | - Magoma Mwancha-Kwasa
- Foundation for Innovative New Diagnostics, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | | | - Audrey Albertini
- Foundation for Innovative New Diagnostics, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Joshua Havumaki
- Foundation for Innovative New Diagnostics, 9 Chemin des Mines, 1202, Geneva, Switzerland.,University of Michigan, 500 S. State Street, Ann Arbor, MI, 48109, USA
| | - Peter Chiodini
- Hospital for Tropical Diseases, Mortimer Market, London, WC1E 6JB, UK
| | - Wellington Oyibo
- Tropical Disease Research Laboratory, Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Iveth J Gonzalez
- Foundation for Innovative New Diagnostics, 9 Chemin des Mines, 1202, Geneva, Switzerland
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Ruckstuhl L, Lengeler C, Moyen JM, Garro H, Allan R. Malaria case management by community health workers in the Central African Republic from 2009-2014: overcoming challenges of access and instability due to conflict. Malar J 2017; 16:388. [PMID: 28962622 PMCID: PMC5622524 DOI: 10.1186/s12936-017-2005-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background In the Central African Republic (CAR), decades of armed conflict have crippled the public health system. This has left the population without timely access to life-saving services and therefore vulnerable to the numerous consequences of infectious diseases, including malaria. As a response, in 2008 an international non-governmental organization started a network of community health workers (CHWs) in the highly malaria-endemic region of northwest CAR. The area has experienced years of violent clashes between rebel groups and seen hundreds of thousands of people displaced. Methods Data from routine patient registers from 80 CHWs working in Paoua and Markounda sub-prefectures were entered and retrospectively reviewed. The time period covered December 2009–April 2014 and hence different stages of conflict and unrest. Several indicators were measured over time, including malaria rapid diagnostic test (RDT) positivity rates, CHW reporting rates, and malnutrition indicators. Results Among nearly 200,000 people who consulted a CHW during this period, 81% were found to be positive for malaria parasites by RDT. In total, 98.9% of these positive cases were appropriately treated with artemisinin-based combination therapy (ACT). Only 1.2% of RDT negative cases were incorrectly treated with an ACT. Monthly data from each CHW were regularly reported, with more than 96% of CHWs reporting each month in the first 3 years of the project. However, since the coup d’état in March 2013, the number of CHWs reporting each month decreased as the programme battled the additional constraints of civil war. Conclusions Although the political crisis affected the CHWs, the programme showed that it could reach those most vulnerable and continue some level of care at all times. In addition, this programme revealed that surveillance could be maintained in conflict zones. This paper fills a significant gap in the knowledge of malaria control in CAR and this is especially important for agencies which must often decide in a short space of time how to respond effectively to complex emergencies.
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Affiliation(s)
- Laura Ruckstuhl
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jean Méthode Moyen
- The National Malaria Control Programme, Bangui, Central African Republic
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Owek CJ, Oluoch E, Wachira J, Estambale B, Afrane YA. Community perceptions and attitudes on malaria case management and the role of community health workers. Malar J 2017; 16:272. [PMID: 28676113 PMCID: PMC5496603 DOI: 10.1186/s12936-017-1916-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/27/2017] [Indexed: 12/02/2022] Open
Abstract
Background Community Case Management of malaria (CCMm) is one of the new approaches adopted by the World Health Organization for malaria endemic countries to reduce the burden of malaria for vulnerable populations. It is based on the evidence that well-trained and supervised community health workers (CHWs) can provide prompt and adequate treatment to fever cases within 24 h to help reduce morbidity and mortality associated with malaria among under-five children. The perception and attitudes of the community members on the CHWs’ role is of greater importance for acceptance of their services. The aim of the study was to assess community’s perception and attitude towards CCMm and on CHWs who undertake it. Methods This study was conducted in five districts in western Kenya where Community Case Management was being undertaken. This was a qualitative cross-sectional study in which in-depth interviews and focus group discussions were conducted with mothers of under-five children and key stakeholders. Results Overall, there were more positive expressions of perceptions and attitudes of the community members towards the CCMm programme and the role of CHWs. The positive perceptions included among others; recognition and appreciation of services of CHWs, bringing health services to close proximity to the community, avoiding long queues in the health facilities, provision of health education that encourages good health practices, and promotion of positive health-seeking behaviour from within the communities. This programme is not without challenges as some of the negative perceptions expressed by the community members included the fact that some clinicians doubt the capacity of CHWs on dispensing drugs in the community, some CHWs do not keep client’s secrets and mistrust of CHWs due to conflicting information by government. Conclusions It was evident that the community had more positive perceptions and attitudes towards the role of CHWs in CCMm than negative ones. There should however, be deliberate efforts towards sustaining the positive aspects and addressing the negative concerns raised by the community and the health care practitioners.
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Affiliation(s)
- Collins J Owek
- Afya Bora Consortium Fellowship Programme, Global Health Leadership, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Juddy Wachira
- Department of Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Benson Estambale
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Yaw A Afrane
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana.
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Hansen KS, Ndyomugyenyi R, Magnussen P, Lal S, Clarke SE. Cost-effectiveness analysis of malaria rapid diagnostic tests for appropriate treatment of malaria at the community level in Uganda. Health Policy Plan 2017; 32:676-689. [PMID: 28453718 PMCID: PMC5406761 DOI: 10.1093/heapol/czw171] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 11/21/2022] Open
Abstract
In Sub-Saharan Africa, malaria remains a major cause of morbidity and mortality among children under 5, due to lack of access to prompt and appropriate diagnosis and treatment. Many countries have scaled-up community health workers (CHWs) as a strategy towards improving access. The present study was a cost-effectiveness analysis of the introduction of malaria rapid diagnostic tests (mRDTs) performed by CHWs in two areas of moderate-to-high and low malaria transmission in rural Uganda. CHWs were trained to perform mRDTs and treat children with artemisinin-based combination therapy (ACT) in the intervention arm while CHWs offered treatment based on presumptive diagnosis in the control arm. Data on the proportion of children with fever 'appropriately treated for malaria with ACT' were captured from a randomised trial. Health sector costs included: training of CHWs, community sensitisation, supervision, allowances for CHWs and provision of mRDTs and ACTs. The opportunity costs of time utilised by CHWs were estimated based on self-reporting. Household costs of subsequent treatment-seeking at public health centres and private health providers were captured in a sample of households. mRDTs performed by CHWs was associated with large improvements in appropriate treatment of malaria in both transmission settings. This resulted in low incremental costs for the health sector at US$3.0 per appropriately treated child in the moderate-to-high transmission area. Higher incremental costs at US$13.3 were found in the low transmission area due to lower utilisation of CHW services and higher programme costs. Incremental costs from a societal perspective were marginally higher. The use of mRDTs by CHWs improved the targeting of ACTs to children with malaria and was likely to be considered a cost-effective intervention compared to a presumptive diagnosis in the moderate-to-high transmission area. In contrast to this, in the low transmission area with low attendance, RDT use by CHWs was not a low cost intervention.
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Affiliation(s)
- Kristian S Hansen
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Denmark
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | | | - Pascal Magnussen
- Centre for Medical Parasitology and Microbiology & Institute of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Sham Lal
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Siân E Clarke
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
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46
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Boyce MR, O'Meara WP. Use of malaria RDTs in various health contexts across sub-Saharan Africa: a systematic review. BMC Public Health 2017; 17:470. [PMID: 28521798 PMCID: PMC5437623 DOI: 10.1186/s12889-017-4398-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/08/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The World Health Organization recommends parasitological confirmation of malaria prior to treatment. Malaria rapid diagnostic tests (RDTs) represent one diagnostic method that is used in a variety of contexts to overcome limitations of other diagnostic techniques. Malaria RDTs increase the availability and feasibility of accurate diagnosis and may result in improved quality of care. Though RDTs are used in a variety of contexts, no studies have compared how well or effectively RDTs are used across these contexts. This review assesses the diagnostic use of RDTs in four different contexts: health facilities, the community, drug shops and schools. METHODS A comprehensive search of the Pubmed database was conducted to evaluate RDT execution, test accuracy, or adherence to test results in sub-Saharan Africa. Original RDT and Plasmodium falciparum focused studies conducted in formal health care facilities, drug shops, schools, or by CHWs between the year 2000 and December 2016 were included. Studies were excluded if they were conducted exclusively in a research laboratory setting, where staff from the study team conducted RDTs, or in settings outside of sub-Saharan Africa. RESULTS The literature search identified 757 reports. A total of 52 studies were included in the analysis. Overall, RDTs were performed safely and effectively by community health workers provided they receive proper training. Analogous information was largely absent for formal health care workers. Tests were generally accurate across contexts, except for in drug shops where lower specificities were observed. Adherence to RDT results was higher among drug shop vendors and community health workers, while adherence was more variable among formal health care workers, most notably with negative test results. CONCLUSIONS Malaria RDTs are generally used well, though compliance with test results is variable - especially in the formal health care sector. If low adherence rates are extrapolated, thousands of patients may be incorrectly diagnosed and receive inappropriate treatment resulting in a low quality of care and unnecessary drug use. Multidisciplinary research should continue to explore determinants of good RDT use, and seek to better understand how to support and sustain the correct use of this diagnostic tool.
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Affiliation(s)
| | - Wendy P O'Meara
- Duke Global Health Institute, Durham, NC, USA.,School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
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47
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Bauer WS, Richardson KA, Adams NM, Ricks KM, Gasperino DJ, Ghionea SJ, Rosen M, Nichols KP, Weigl BH, Haselton FR, Wright DW. Rapid concentration and elution of malarial antigen histidine-rich protein II using solid phase Zn(II) resin in a simple flow-through pipette tip format. BIOMICROFLUIDICS 2017; 11:034115. [PMID: 28652885 PMCID: PMC5457299 DOI: 10.1063/1.4984788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/18/2017] [Indexed: 05/31/2023]
Abstract
Rapid diagnostic tests (RDTs) designed to function at the point of care are becoming more prevalent in malaria diagnostics because of their low cost and simplicity. While many of these tests function effectively with high parasite density samples, their poor sensitivity can often lead to misdiagnosis when parasitemia falls below 100 parasites/μl. In this study, a flow-through pipette-based column was explored as a cost-effective means to capture and elute more Plasmodium falciparum histidine-rich protein II (HRPII) antigen, concentrating the biomarker available in large-volume lysed whole blood samples into volumes compatible with Plasmodium falciparum-specific RDTs. A systematic investigation of immobilized metal affinity chromatography divalent metal species and solid phase supports established the optimal design parameters necessary to create a flow-through column incorporated into a standard pipette tip. The bidirectional flow inherent to this format maximizes mixing efficiency so that in less than 5 min of sample processing, the test band signal intensity was increased up to a factor of twelve from HRPII concentrations as low as 25 pM. In addition, the limit of detection per sample was decreased by a factor of five when compared to the RDT manufacturer's suggested protocol. Both the development process and commercial viability of this application are explored, serving as a potential model for future applications.
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Affiliation(s)
- Westley S Bauer
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Kelly A Richardson
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Nicholas M Adams
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Keersten M Ricks
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - David J Gasperino
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Simon J Ghionea
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Mathew Rosen
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Kevin P Nichols
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Bernhard H Weigl
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | | | - David W Wright
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
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Harvey SA, Incardona S, Martin N, Lussiana C, Streat E, Dolan S, Champouillon N, Kyabayinze DJ, Mugerwa R, Nakanwagi G, Njoki N, Rova R, Cunningham J. Quality issues with malaria rapid diagnostic test accessories and buffer packaging: findings from a 5-country private sector project in Africa. Malar J 2017; 16:160. [PMID: 28427428 PMCID: PMC5397682 DOI: 10.1186/s12936-017-1820-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/13/2017] [Indexed: 12/02/2022] Open
Abstract
Background Use of antigen-detecting malaria rapid diagnostic tests (RDTs) has increased exponentially over the last decade. WHO’s Global Malaria Programme, FIND, and other collaborators have established a quality assurance scheme to guide product selection, lot verification, transport, storage, and training procedures. Recent concerns over the quality of buffer packaging and test accessories suggest a need to include these items in product assessments. This paper describes quality problems with buffer and accessories encountered in a project promoting private sector RDT use in five African countries and suggests steps to avoid or more rapidly identify and resolve such problems. Methods Private provider complaints about RDT buffer vials and kit accessories were collected during supervisory visits, and a standard assessment process was developed. Using 100 tests drawn from six different lots produced by two manufacturers, lab technicians visually assessed alcohol swab packaging, blood transfer device (BTD) usability, and buffer appearance, then calculated mean blood volume from 10 BTD transfers and mean buffer volume from 10 individual buffer vials. WHO guided complaint reporting and follow-up with manufacturers. Results Supervisory visits confirmed user reports of dry alcohol swabs, poorly functioning BTDs, and non-uniform volumes of buffer. Lot testing revealed further evidence of quality problems, leading one manufacturer to replace buffer vials and accessories for 40,000 RDTs. In December 2014, WHO issued an Information Notice for Users regarding variable buffer volumes in single-use vials and recommended against procurement of these products until defects were addressed. Discussion Though not necessarily comprehensive or generalizable, the findings presented here highlight the need for extending quality assessment to all malaria RDT test kit contents. Defects such as those described in this paper could reduce test accuracy and increase probability of invalid, false positive, or false negative results. Such deficiencies could undermine provider confidence in RDTs, prompting a return to presumptive treatment or reliance on poor quality microscopy. In partial response to this experience, WHO, FIND, and other project partners have developed guidance on documenting, troubleshooting, reporting, and resolving such problems when they occur. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1820-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven A Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Sandra Incardona
- FIND (Foundation for Innovative New Diagnostics), Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Nina Martin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Cristina Lussiana
- Population Services International, 1120 19th Street, NW, Suite 600, Washington, DC, 20036, USA
| | - Elizabeth Streat
- Malaria Consortium, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
| | - Stephanie Dolan
- Population Services International, 1120 19th Street, NW, Suite 600, Washington, DC, 20036, USA
| | - Nora Champouillon
- FIND (Foundation for Innovative New Diagnostics), Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Daniel J Kyabayinze
- FIND (Foundation for Innovative New Diagnostics), Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Robert Mugerwa
- Malaria Consortium, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
| | - Grace Nakanwagi
- Malaria Consortium, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
| | - Nancy Njoki
- Population Services International, 1120 19th Street, NW, Suite 600, Washington, DC, 20036, USA
| | - Ratsimandisa Rova
- Population Services International, 1120 19th Street, NW, Suite 600, Washington, DC, 20036, USA
| | - Jane Cunningham
- World Health Organization, Global Malaria Programme, 20, Avenue Appia, 1211, Geneva 27, Switzerland
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de Vries DH, Pool R. The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review. PLoS One 2017; 12:e0170217. [PMID: 28095475 PMCID: PMC5240984 DOI: 10.1371/journal.pone.0170217] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/02/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite the availability of practical knowledge and effective interventions required to reduce priority health problems in low-income countries, poor and vulnerable populations are often not reached. One possible solution to this problem is the use of Community or Lay Health Workers (CLHWs). So far, however, the development of sustainability in CLHW programs has failed and high attrition rates continue to pose a challenge. We propose that the roles and interests which support community health work should emerge directly from the way in which health is organized at community level. This review explores the evidence available to assess if increased levels of integration of community health resources in CLHW programs indeed lead to higher program effectiveness and sustainability. METHODS AND FINDINGS This review includes peer-reviewed articles which meet three eligibility criteria: 1) specific focus on CLHWs or equivalent; 2) randomized, quasi-randomized, before/after methodology or substantial descriptive assessment; and 3) description of a community or peer intervention health program located in a low- or middle-income country. Literature searches using various article databases led to 2930 hits, of which 359 articles were classified. Of these, 32 articles were chosen for extensive review, complemented by analysis of the results of 15 other review studies. Analysis was conducted using an excel based data extraction form. Because results showed that no quantitative data was published, a descriptive synthesis was conducted. The review protocol was not proactively registered. Findings show minimal inclusion of even basic community level indicators, such as the degree to which the program is a community initiative, community input in the program or training, the background and history of CLHW recruits, and the role of the community in motivation and retention. Results show that of the 32 studies, only one includes one statistical measure of community integration. As a result of this lack of data we are unable to derive an evidence-based conclusion to our propositions. Instead, our results indicate a larger problem, namely the complete absence of indicators measuring community relationships with the programs studied. Studies pay attention only to gender and peer roles, along with limited demographic information about the recruits. The historicity of the health worker and the community s/he belongs to is absent in most studies reviewed. None of the studies discuss or test for the possibility that motivation emanates from the community. Only a few studies situate attrition and retention as an issue enabled by the community. The results were limited by a focus on low-income countries and English, peer-reviewed published articles only. CONCLUSION Published, peer-reviewed studies evaluating the effectiveness and sustainability of CLHW interventions in health programs have not yet adequately tested for the potential of utilizing existing community health roles or social networks for the development of effective and sustainable (retentive) CLHW programs. Community relationships are generally seen as a "black box" represented by an interchangeable CLHW labor unit. This disconnect from community relationships and resources may have led to a systematic and chronic undervaluing of community agency in explanations of programmatic effectiveness and sustainability.
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Affiliation(s)
- Daniel H. de Vries
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Pool
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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50
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Sunguya BF, Mlunde LB, Ayer R, Jimba M. Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review. Malar J 2017; 16:10. [PMID: 28049486 PMCID: PMC5209914 DOI: 10.1186/s12936-016-1667-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human resource for health crisis has impaired global efforts against malaria in highly endemic countries. To address this, the World Health Organization (WHO) recommended scaling-up of community health workers (CHWs) and related cadres owing to their documented success in malaria and other disease prevention and management. Evidence is inconsistent on the roles and challenges they encounter in malaria interventions. This systematic review aims to summarize evidence on roles and challenges of CHWs and related cadres in integrated community case management for malaria (iCCM). METHODS This systematic review retrieved evidence from PubMed, CINAHL, ISI Web of Knowledge, and WHO regional databases. Terms extracted from the Boolean phrase used for PubMed were also used in other databases. The review included studies with Randomized Control Trial, Quasi-experimental, Pre-post interventional, Longitudinal and cohort, Cross-sectional, Case study, and Secondary data analysis. Because of heterogeneity, only narrative synthesis was conducted for this review. RESULTS A total of 66 articles were eligible for analysis out of 1380 studies retrieved. CHWs and related cadre roles in malaria interventions included: malaria case management, prevention including health surveillance and health promotion specific to malaria. Despite their documented success, CHWs and related cadres succumb to health system challenges. These are poor and unsustainable finance for iCCM, workforce related challenges, lack of and unsustainable supply of medicines and diagnostics, lack of information and research, service delivery and leadership challenges. CONCLUSIONS Community health workers and related cadres had important preventive, case management and promotive roles in malaria interventions. To enable their effective integration into the health systems, the identified challenges should be addressed. They include: introducing sustainable financing on iCCM programmes, tailoring their training to address the identified gaps, improving sustainable supply chain management of malaria drugs and diagnostics, and addressing regulatory challenges in the local contexts.
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Affiliation(s)
- Bruno F. Sunguya
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Linda B. Mlunde
- Management for Development and Health, Dar es Salaam, Tanzania
| | - Rakesh Ayer
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
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