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Musoke D, Lubega GB, Niyongabo F, Nakalawa S, McMorrow S, Wanyenze RK, Kamya MR. Facilitators and barriers to integrated malaria prevention in Wakiso district, Uganda: A photovoice study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002469. [PMID: 38626091 PMCID: PMC11020531 DOI: 10.1371/journal.pgph.0002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
Malaria continues to cause significant morbidity and mortality globally, particularly in sub-Saharan Africa. Appropriate combinations of non-chemical and chemical methods of malaria vector control in the context of integrated vector management have been recommended by the World Health Organization. The aim of the study was to explore facilitators and barriers to using integrated malaria prevention in Wakiso district, Uganda. This qualitative study employed photovoice among 20 community members in Kasanje Town Council, Wakiso District. The photos taken by participants for 5 months using smartphones were discussed during monthly meetings with the researchers. The discussions were audio-recorded, and resulting data analysed using thematic analysis with the support of NVivo (2020) QSR International. Findings indicated that various conventional and non-conventional measures were being used for preventing malaria such as: insecticide treated nets; clearing overgrown vegetation; draining stagnant water; mosquito coils; smouldering of cow dung; spraying insecticides; plant repellents near houses; eating of prophylactic herbs; as well as closing doors and windows on houses early in the evening. Facilitators supporting the use of several malaria prevention methods holistically included: low cost and accessibility of some methods such as slashing overgrown vegetation; and support provided for certain methods such as receiving free mosquito nets from the government. Barriers to using several malaria prevention methods holistically included: inadequate knowledge of some methods such as housing improvement; allergic reactions to chemical-based methods such as insecticide treated nets; unaffordability of some methods such as insecticide sprays; and inaccessibility of certain methods such as body repellents. These barriers to integrated malaria prevention need to be addressed to achieve greater impact from the combination of methods in endemic communities.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace B. Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Filimin Niyongabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Suzan Nakalawa
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Shannon McMorrow
- School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, Michigan, United States of America
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Prevention of Malaria in Pregnancy: What Do the Pregnant Women of Nigeria Know and Do about It? Infect Dis Obstet Gynecol 2022; 2022:7061548. [PMID: 36438171 PMCID: PMC9699741 DOI: 10.1155/2022/7061548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
Objective We assessed knowledge, attitude, and practice regarding two malaria prevention measures (long-lasting impregnated mosquito nets, LLINs, and intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP)) among pregnant women in Nigeria. Methods Pregnant women selected from among the four communities of Nnewi were interviewed by using a semistructured, interviewer-administered questionnaire on the respondents' demography, knowledge of the cause, consequences, and malaria prevention methods. Also, a total of 48 focused group discussions, 24 key informant interviews, and 24 in-depth interviews were held among women leaders, village heads, pregnant women, community health workers, husbands of pregnant wives, and drug and insecticide-treated net sellers. Results A total of 384 women (88.0% third trimester, 90.0% literate, and 41.1% primigravidae) participated. About 80.0% suffered from malaria during their current pregnancy. The majority was aware of the cause of malaria, local name of malaria, mode of transmission, risk of malaria among pregnant women, etc. However, their knowledge and attitude were inadequate regarding the symptomatology and complications of malaria in pregnancy, benefits of sleeping under the net or taking chemoprophylactic doses, or the concurrent use of both. About 80.0% had LLINs, yet only 41.5% slept under it the previous night. Only 31.0% had IPTp-SP doses under direct observation. Only 35.9% had a good understanding of IPTp-SP during pregnancy. Conclusion Our work presents important practice gaps associated with the prevention of malaria during pregnancy. The pregnant women seemed to be aware of the basic concepts related to malaria but that does not translate into adequate attitude and practice necessary for malaria reduction.
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Abstract
BACKGROUND The World Health Organization (WHO) recommends parasitological testing of all suspected malaria cases using malaria rapid diagnostic tests (mRDTs) or microscopy prior to treatment. Some governments have extended this responsibility to community health workers (CHWs) to reduce malaria morbidity and mortality through prompt and appropriate treatment. This is an update of a Cochrane Review first published in 2013. OBJECTIVES To evaluate community-based management strategies for treating malaria or fever that incorporate both a definitive diagnosis with an mRDT and appropriate antimalarial treatment. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases, and three trials registers up to 14 September 2021. SELECTION CRITERIA We included individually randomized trials and cluster-randomized controlled trials (cRCTs), controlled before-after studies, and controlled interrupted time series studies in people living in malaria-endemic areas, comparing programmes that train CHWs and drug shop vendors to perform mRDTs and provide appropriate treatment versus similar programmes that do not use mRDTs, and versus routine health facility care. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. For each dichotomous outcome, we extracted the number of participants with the event and the total number of participants in each group, unless studies presented results at a population level only. Primary outcomes were all-cause mortality, hospitalizations, and number of people receiving an antimalarial within 24 hours. Secondary outcomes were malaria-specific mortality, severe malaria, outcomes related to antimalarial treatments, antibiotic prescribing to people with a negative microscopy or polymerase chain reaction (PCR) result, parasitaemia, anaemia, and all adverse events. MAIN RESULTS We included eight studies from several African countries, Afghanistan, and Myanmar. Staff included CHWs and drug shop vendors. Community use of malaria rapid diagnostic tests compared to clinical diagnosis Compared to clinical diagnosis, mRDT diagnosis results in reduced prescribing of antimalarials to people who are found to be malaria parasite-negative by microscopy or PCR testing (71 fewer per 100 people, 95% confidence interval (CI) 79 to 51 fewer; risk ratio (RR) 0.17, 95% CI 0.07 to 0.40; 3 cRCTs, 7877 participants; moderate-certainty evidence). This reduction may be greater among CHWs compared to drug shop vendors. People diagnosed by mRDT are more likely to receive appropriate treatment; that is, an antimalarial if they are microscopy- or PCR-positive and no antimalarial if they are microscopy- or PCR-negative (RR 3.04, 95% CI 2.46 to 3.74, 3 cRCTs, 9332 participants; high-certainty evidence). Three studies found that a small percentage of people with a negative mRDT result (as read by the CHW or drug shop vendors at the time of treatment) were nevertheless given an antimalarial: 38/1368 (2.8%), 44/724 (6.1%) and 124/950 (13.1%). Conversely, in two studies, a few mRDT-positive people did not receive an antimalarial (0.5% and 0.3%), and one small cross-over study found that 6/57 (10.5%) people classified as non-malaria in the clinical diagnosis arm received an antimalarial. Use of mRDTs probably increases antibiotic use compared to clinical diagnosis (13 more per 100 people, 95% CI 3 to 29 more; RR 2.02, 95% CI 1.21 to 3.37; 2 cRCTs, 5179 participants; moderate-certainty evidence). We were unable to demonstrate any effect on mortality. Community use of malaria rapid diagnostic tests compared to health facility care Results were insufficient to reach any conclusion. AUTHORS' CONCLUSIONS Use of mRDTs by CHWs and drug shop vendors compared to clinical diagnosis reduces prescribing of antimalarials to people without malaria. Deaths were uncommon in both groups. Antibiotic prescribing was higher in those with a negative mRDT than in those with a negative clinical diagnosis.
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Affiliation(s)
- Elizabeth N Allen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Alison Beriliy Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Michael McCaul
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Montiel Ishino FA, Rowan C, Talham C, Villalobos K, Poudel D, Rajbhandari-Thapa J, Ambikile JS, Williams F. Household profiles of neglected tropical disease symptoms among children: A latent class analysis of built-environment features of Tanzanian households using the Demographic and Health Survey. J Glob Health 2022; 12:04067. [PMID: 36057837 PMCID: PMC9441010 DOI: 10.7189/jogh.12.04067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background While malaria and neglected tropical disease (NTD) morbidity and mortality rates among children <5 years old have decreased through public health efforts in the United Republic of Tanzania, associations between household environments and disease outcomes are relatively unknown. Methods We conducted latent class analysis (LCA) on 2015-2016 Tanzania Demographic Health Survey data from mothers with children <5 years old (N = 10 233) to identify NTD household risk profiles. The outcome of child NTD was assessed by mothers’ reports of recent diarrhoea, cough, treatment for enteric parasites, and fever symptoms. Household-built environment indicators included urban/rural designation, electricity access, water source, cooking fuel, flooring, wall, and roofing materials. External environmental covariates were considered to further differentiate profiles. Results Five profiles were identified in the sample: rural finished walls households (40.2%) with the lowest NTD risk; rural rudimentary households (20.9%) with intermediate-low NTD risk; finished material households (22.5%) with intermediate NTD risk; urban households (14.4%) with intermediate-high NTD risk and high likelihood of enteric parasites; rural finished roof/walls households (2.1%) with the highest overall NTD risk. Conclusions This study is among the first to use LCA to examine household environment characteristics to assess child NTD risk in Tanzania. This paper serves as a framework for community-level rapid NTD risk assessment for targeted health promotion interventions.
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Affiliation(s)
- Francisco A Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Claire Rowan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Charlotte Talham
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Dikshit Poudel
- Department of Agricultural and Applied Economics, College of Agricultural and Environmental Science, University of Georgia, Athens, Georgia, USA
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Joel Seme Ambikile
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Sharma N, Asaf A, Vaivada T, Bhutta ZA. Delivery Strategies Supporting School-Age Child Health: A Systematic Review. Pediatrics 2022; 149:186937. [PMID: 35503326 DOI: 10.1542/peds.2021-053852l] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
CONTEXT School-aged children (SAC; 5-9 years) remain understudied in global efforts to examine intervention effectiveness and scale up evidence-based interventions. OBJECTIVE This review summarizes the available evidence describing the effectiveness of key strategies to deliver school-age interventions. DATA SOURCES We searched Medline, PsycINFO, Campbell Collaboration, and The Cochrane Library during November 2020. STUDY SELECTION Systematic reviews and meta-analyses that: target SAC, examine effective delivery of well-established interventions, focus on low- and middle-income countries (LMICs), were published after 2010, and focus on generalizable, rather than special, populations. DATA EXTRACTION Two reviewers conducted title and abstract screening, full-text screening, data extraction, and quality assessments. RESULTS Sixty reviews met the selection criteria, with 35 containing evidence from LMICs. The outcomes assessed and the reported effectiveness of interventions varied within and across delivery strategies. Overall, community, school, and financial strategies improved several child health outcomes. The greatest evidence was found for the use of community-based interventions to improve infectious disease outcomes, such as malaria control and prevention. School-based interventions improved child development and infectious disease-related outcomes. Financial strategies improved school enrollment, food security, and dietary diversity. LIMITATIONS Relatively few LMIC studies examined facility, digital, and self-management strategies. Additionally, we found considerable heterogeneity within and across delivery strategies and review authors reported methodological limitations within the studies. CONCLUSIONS Despite limited research, available information suggests community-based strategies can be effective for the introduction of a range of interventions to support healthy growth and development in SAC. These also have the potential to reduce disparities and reach at-risk and marginalized populations.
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Affiliation(s)
- Naeha Sharma
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Ayesha Asaf
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,Center of Excellence in Women and Child Health, Institute for Global Health & Development, Aga Khan University Hospital, Karachi, Pakistan
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Lu G, Cao Y, Chai L, Li Y, Li S, Heuschen AK, Chen Q, Müller O, Cao J, Zhu G. Barriers to seeking health care among returning travellers with malaria: A systematic review. Trop Med Int Health 2021; 27:28-37. [PMID: 34748264 DOI: 10.1111/tmi.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify barriers to seeking health care among returning travellers with malaria with the aim of developing targeted interventions that improve early health care-seeking behaviour, diagnosis and treatment. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of published medical literature, selecting studies that investigated and reported barriers to seeking health care among returning travellers and migrants with malaria. In total, 633 articles were screened, of which four studies met the inclusion criteria after a full-text review. RESULTS The four studies reported barriers to seeking healthcare among returning travellers in China, the United States, Thailand and the Dominican Republic. Three studies had an observational design. The identified barriers were summarised based on the appraisal delay, illness delay and utilisation delay stages. During appraisal delays, low awareness of malaria was the most significant factor. Once the patient assessed that he or she was ill, belonging to a specific minority ethnicity, being infected with P. vivax and receiving a low level of social support were predictors of delayed health care-seeking. Finally, the most significant factor associated with utilisation delays was the monetary cost. CONCLUSION The health care-seeking behaviour of returning travellers with malaria should be further investigated and improved. Addressing the identified barriers and gaps in health care-seeking behaviour among returning travellers with malaria, particularly among groups at high risk of travel-associated infections, is important to prevent severe disease and deaths as well as secondary transmission and epidemics.
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Affiliation(s)
- Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yuanyuan Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Liying Chai
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Jiangsu North People's Hospital, Medical College of Yangzhou University, Yangzhou, China
| | - Shuying Li
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | | | - Qi Chen
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Olaf Müller
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jun Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Guoding Zhu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
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Aliye M, Hong T. Role of health extension workers in the relationship between vector control interventions and malaria in Ethiopia. BMC Infect Dis 2021; 21:1140. [PMID: 34749657 PMCID: PMC8573560 DOI: 10.1186/s12879-021-06040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite a tremendous decline in the burden of malaria through public health interventions, it is yet remains a critical parasitic health problem in Ethiopia. Insecticide-treated nets and indoor residual spray are considered as the most effective preventive interventions against malaria. This study intended to determine the role of health extension workers in influencing the relationship between vector control strategies and malaria prevalence in Ethiopia. METHODS The study adopted a descriptive study based on panel data collected from 10 regions of Ethiopia from 2010 to 2018. The data collected were analyzed using STATA version 13.0. Structural equation modelling was used to assess the mediating effect of health extension workers in the relationship. Further, the random effect model was employed to investigate the direct relationship among the study variables. RESULTS We observed a strong mediating role of health extension workers to the relationship between strategic interventions and malaria prevalence, where the direct path is (β = 0.64, p < 0.05), and the indirect path (β = 0.72, p < 0.001) and (β = 0.98, p < 0.001) confirming the mediation condition to appear. Our analysis revealed that, insecticide-treated nets and indoor residual spray significantly impacts the malaria prevalence (β = 0.20, p < 0.05) and (β = 0.70, p < 0.001) respectively. Further, our analysis suggests that the cumulative effect of indoor residual spray and insecticide-treated mosquito nets have helped better avert malaria prevalence (β = 81.3%, P < 0.05). Moreover, the finding demonstrates the incremental rate of 30.2%, which is the indirect effect of the research [(β = 0.813) - (β1 = 0.511)]. CONCLUSION The findings are potentially useful for the health sector in charge of infectious disease prevention and control, particularly in developing countries explaining how these group provided support to reduce malaria ensuring the provision of proper health message about the program.
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Affiliation(s)
- Mohammed Aliye
- School of Management, Harbin Institute of Technology, 150001, Harbin, P.R. China
| | - Tao Hong
- Harbin Institute of Technology, Harbin, Heilongjiang province, China.
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Nkosi-Gondwe T, Robberstad B, Mukaka M, Idro R, Opoka RO, Banda S, Kühl MJ, O. Ter Kuile F, Blomberg B, Phiri KS. Adherence to community versus facility-based delivery of monthly malaria chemoprevention with dihydroartemisinin-piperaquine for the post-discharge management of severe anemia in Malawian children: A cluster randomized trial. PLoS One 2021; 16:e0255769. [PMID: 34506503 PMCID: PMC8432777 DOI: 10.1371/journal.pone.0255769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 07/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background The provision of post-discharge malaria chemoprevention (PMC) in children recently admitted with severe anemia reduces the risk of death and re-admissions in malaria endemic countries. The main objective of this trial was to identify the most effective method of delivering dihydroartemesinin-piperaquine to children recovering from severe anemia. Methods This was a 5-arm, cluster-randomized trial among under-5 children hospitalized with severe anemia at Zomba Central Hospital in Southern Malawi. Children were randomized to receive three day treatment doses of dihydroartemesinin-piperaquine monthly either; 1) in the community without a short text reminder; 2) in the community with a short message reminder; 3) in the community with a community health worker reminder; 4) at the facility without a short text reminder; or 5) at the facility with a short message reminder. The primary outcome measure was adherence to all treatment doses of dihydroartemesinin-piperaquine and this was assessed by pill-counts done by field workers during home visits. Poisson regression was utilized for analysis. Results Between March 2016 and October 2018, 1460 clusters were randomized. A total of 667 children were screened and 375 from 329 clusters were eligible and enrolled from the hospital. Adherence was higher in all three community-based compared to the two facility-based delivery (156/221 [70·6%] vs. 78/150 [52·0%], IRR = 1·24,95%CI 1·06–1·44, p = 0·006). This was observed in both the SMS group (IRR = 1·41,1·21–1·64, p<0·001) and in the non-SMS group (IRR = 1·37,1·18–1·61, p<0·001). Although adherence was higher among SMS recipients (98/148 66·2%] vs. non-SMS 82/144 (56·9%), there was no statistical evidence that SMS reminders resulted in greater adherence ([IRR = 1·03,0·88–1·21, p = 0·68). When compared to the facility-based non-SMS arm (control arm), community-based delivery utilizing CHWs resulted in higher adherence [39/76 (51·3%) vs. 54/79 (68·4%), IRR = 1·32, 1·14–1·54, p<0·001]. Interpretation Community-based delivery of dihydroartemesinin-piperaquine for post-discharge malaria chemoprevention in children recovering from severe anemia resulted in higher adherence compared to facility-based methods. Trial registration NCT02721420; ClinicalTrials.gov.
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Affiliation(s)
- Thandile Nkosi-Gondwe
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Bjarne Robberstad
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
| | - Richard Idro
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert O. Opoka
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Saidon Banda
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Melf-Jakob Kühl
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Feiko O. Ter Kuile
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bjorn Blomberg
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kamija S. Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Enguita-Fernàndez C, Alonso Y, Lusengi W, Mayembe A, Manun'Ebo MF, Ranaivontiavina S, Rasoamananjaranahary AM, Mucavele E, Macete E, Nwankwo O, Meremikwu M, Roman E, Pagnoni F, Menéndez C, Munguambe K. Trust, community health workers and delivery of intermittent preventive treatment of malaria in pregnancy: a comparative qualitative analysis of four sub-Saharan countries. Glob Public Health 2020; 16:1889-1903. [PMID: 33290172 DOI: 10.1080/17441692.2020.1851742] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This qualitative study is part of a project aiming to evaluate a community-based approach to the delivery of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) through community health workers (CHWs) in four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. The study aimed to understand the factors that influence the anticipated acceptability of this intervention. A total of 216 in-depth interviews and 62 focus group discussions were carried out in the four country sites with pregnant women, women of reproductive age, community leaders, pregnant women's relatives, CHWs, formal and informal health providers. Grounded theory guided the study design and data collection, and content and thematic analysis was performed through a comparative lens. This paper focuses on one crosscutting theme: trust-building. Two mechanisms that underpin communities' trust in delivery of IPTp via CHWs were identified: 'perceived competence' and 'community and healthcare system integration'. Communities' perception of CHWs' competence shapes their trust in them, which suggests that CHWs' credentials should be made public and that specialised training in maternal health is required for them. Integration depends on the promotion of socially embedded practices and the involvement of formal healthcare systems in CHWs' work.
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Affiliation(s)
| | - Yara Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Wade Lusengi
- Bureau d'Étude et de Gestion de l'Information Statistique (BÉGIS), Kinshasa, DRC
| | - Alain Mayembe
- Bureau d'Étude et de Gestion de l'Information Statistique (BÉGIS), Kinshasa, DRC
| | - Manu F Manun'Ebo
- Bureau d'Étude et de Gestion de l'Information Statistique (BÉGIS), Kinshasa, DRC
| | - Sylviane Ranaivontiavina
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | | | - Estêvão Mucavele
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ogonna Nwankwo
- Department of Community Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Cross River State, Nigeria
| | - Elaine Roman
- Jhpiego, affiliate of Johns Hopkins University, Baltimore, Maryland, USA
| | - Franco Pagnoni
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP)
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Moorthy D, Merrill R, Namaste S, Iannotti L. The Impact of Nutrition-Specific and Nutrition-Sensitive Interventions on Hemoglobin Concentrations and Anemia: A Meta-review of Systematic Reviews. Adv Nutr 2020; 11:1631-1645. [PMID: 32845972 PMCID: PMC7666908 DOI: 10.1093/advances/nmaa070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/12/2020] [Accepted: 05/21/2020] [Indexed: 11/14/2022] Open
Abstract
Anemia is a multifactorial condition arising from inadequate nutrition, infection, chronic disease, and genetic-related etiologies. Our aim was to assess the impact of nutrition-sensitive and nutrition-specific interventions on hemoglobin (Hb) concentrations and anemia to inform the prioritization and scale-up of interventions to address the multiple causes of anemia. We performed a meta-review synthesis of information by searching multiple databases for reviews published between 1990 and 2017 and used standard methods for conducting a meta-review of reviews, including double independent screening, extraction, and quality assessment. Quantitative pooling and narrative syntheses were used to summarize information. Hb concentration and anemia outcomes were pooled in specific population groups (children aged <5 y, school-age children, and pregnant women). Methodological quality of the systematic reviews was assessed using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. Of the 15,444 records screened, we identified 118 systematic reviews that met inclusion criteria. Reviews focused on nutrition-specific interventions (96%). Daily and intermittent iron supplementation, micronutrient powders, malaria treatment, use of insecticide-treated nets (ITNs), and delayed cord clamping were associated with increased Hb concentration in children aged <5 y. Among children older than 5 y, daily and intermittent iron supplementation and deworming, and in pregnant women, daily iron-folic acid supplementation, use of ITNs, and delayed cord clamping, were associated with increased Hb concentration. Similar results were obtained for the reduced risk of anemia outcome. This meta-review suggests the importance of nutrition-specific interventions for anemia and highlights the lack of evidence to understand the influence of nutrition-sensitive and multifaceted interventions on the condition.
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Affiliation(s)
- Denish Moorthy
- USAID Advancing Nutrition (USAID AN), Arlington, VA, USA
| | - Rebecca Merrill
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sorrel Namaste
- The Demographic and Health Survey Program, ICF, Rockville, MD, USA
| | - Lora Iannotti
- Brown School, Institute for Public Health, Washington University in St Louis, MO, USA
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11
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Win Han Oo, Gold L, Moore K, Agius PA, Fowkes FJI. The impact of community-delivered models of malaria control and elimination: a systematic review. Malar J 2019; 18:269. [PMID: 31387588 PMCID: PMC6683427 DOI: 10.1186/s12936-019-2900-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background Community-delivered models have been widely used to reduce the burden of malaria. This review aimed to explore different community-delivered models and their relative effectiveness in terms of coverage and malaria-metric outcomes in order to inform the design and implementation of Community Health Worker (CHW) programmes for malaria control and elimination. Methods A systematic review of studies investigating the impact of community-delivered models on coverage and malaria-metric (parasitaemia and hyperparasitaemia, malaria case and mortality, anaemia, and fever) outcomes compared to non- community-delivered models was undertaken by searching in five databases of published papers and grey literature databases. Data were extracted from studies meeting inclusion and quality criteria (assessed using relevant tools for the study design) by two independent authors. Meta-analyses were performed where there was sufficient homogeneity in effect and stratified by community-delivered models to assess the impact of each model on coverage and malaria-metric outcomes. Results 28 studies were included from 7042 records identified. The majority of studies (25/28) were performed in high transmission settings in Africa and there was heterogeneity in the type of, and interventions delivered as part of the community-delivered models. Compared to non- community-delivered models, community-delivered models increased coverage of actual bed net usage (Relative Risk (RR) = 1.64 95% CI 1.39, 1.95), intermittent preventive treatment in pregnancy (RR = 1.36 95% CI 1.29, 1.44) and appropriate and timely treatment of febrile children, and improved malaria-metric outcomes such as malaria mortality (RR = 0.58 95% CI 0.52, 0.65). However, the considerable heterogeneity was found in the impact of community-delivered models in reducing, parasitaemia and hyperparasitaemia prevalence, anaemia incidence, fever prevalence and malaria caseload. Statistical comparisons of different community-delivered models were not undertaken due to the heterogeneity of the included studies in terms of method and interventions provided. Conclusion Overall, the community-delivered model is effective in improving the coverage of malaria interventions and reducing malaria-associated mortality. The heterogeneity of the community-delivered models and their impact on malaria-metric indices suggests that evidence for context-specific solutions is required. In particular, community-delivered models for malaria elimination, integrated with services for other common primary health problems, are yet to be evaluated. Electronic supplementary material The online version of this article (10.1186/s12936-019-2900-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Win Han Oo
- School of Health and Social Development, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia. .,Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Lisa Gold
- School of Health and Social Development, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - Kerryn Moore
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie St, Carlton, Melbourne, VIC, 3053, Australia
| | - Paul A Agius
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Judith Lumley Centre, La Trobe University, Level 3, George Singer Building Bundoora, Melbourne, VIC, 3086, Australia
| | - Freya J I Fowkes
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, 235 Bouverie St, Carlton, Melbourne, VIC, 3053, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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12
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Wang D, Chaki P, Mlacha Y, Gavana T, Michael MG, Khatibu R, Feng J, Zhou ZB, Lin KM, Xia S, Yan H, Ishengoma D, Rumisha S, Mkude S, Mandike R, Chacky F, Dismasi C, Abdulla S, Masanja H, Xiao N, Zhou XN. Application of community-based and integrated strategy to reduce malaria disease burden in southern Tanzania: the study protocol of China-UK-Tanzania pilot project on malaria control. Infect Dis Poverty 2019; 8:4. [PMID: 30646954 PMCID: PMC6334450 DOI: 10.1186/s40249-018-0507-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/16/2018] [Indexed: 11/26/2022] Open
Abstract
Background During the past six decades, remarkable success on malaria control has been made in China. The major experience could be shared with other malaria endemic countries including Tanzania with high malaria burden. Especially, China’s 1–3-7 model for malaria elimination is one of the most important refined experiences from many years’ efforts and key innovation measures for malaria elimination in China. Methods The China-UK-Tanzania pilot project on malaria control was implemented from April, 2015 to June, 2018, which was an operational research with two communities receiving the proposed interventions and two comparable communities serving as control sites. The World Health Organization “Test, Treat, Track” (WHO-T3) Initiative, which calls for every suspected case to receive a diagnostic test, every confirmed case to be treated, and for the disease to be tracked, was integrated with Chinese experiences on malaria control and elimination for exploration of a proper model tailored to the local settings. Application of China’s 1–3-7 model integrating with WHO-T3 initiative and local resources aiming at reducing the burden of malaria in terms of morbidity and mortality by 30% in the intervention communities in comparison with that at the baseline survey. Discussion The China-UK-Tanzania pilot project on malaria control was that at China's first pilot project on malaria control in Africa, exploring the feasibility of Chinese experiences by China-Africa collaboration, which is expected that the strategies and approaches used in this project could be potential for scaling up in Tanzania and African countries, and contribute to the acceleration of malaria control and elimination in Africa. Electronic supplementary material The online version of this article (10.1186/s40249-018-0507-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duoquan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, People's Republic of China
| | - Prosper Chaki
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Yeromin Mlacha
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Tegemeo Gavana
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | | | - Rashid Khatibu
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Jun Feng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, People's Republic of China
| | - Zheng-Bin Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, People's Republic of China
| | - Kang-Ming Lin
- Guangxi Center for Disease Control and Prevention, Naning, People's Republic of China
| | - Shang Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, People's Republic of China
| | - He Yan
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Deus Ishengoma
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Susan Rumisha
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Sigbert Mkude
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
| | - Renata Mandike
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
| | - Frank Chacky
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
| | - Charles Dismasi
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
| | - Salim Abdulla
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, People's Republic of China.
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, People's Republic of China.
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13
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Musoke D, Karani G, Morris K, Ndejjo R, Atusingwize E, Guwatudde D, Musoke MB. Integrated approach to malaria prevention at household level in rural communities in Wakiso district, Uganda: impact evaluation of a pilot project. Afr Health Sci 2018; 18:1144-1156. [PMID: 30766580 PMCID: PMC6354846 DOI: 10.4314/ahs.v18i4.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The integrated approach to malaria prevention, which advocates for the use of several malaria prevention methods at households, is being explored to complement other existing strategies. We implemented a pilot project that promoted the integrated approach to malaria prevention in two rural communities in Wakiso district, Uganda. Objectives This paper presents the impact evaluation findings of the project carried out 2 years after implementation with a focus on changes in knowledge and practices on malaria prevention. Methods The project evaluation was cross-sectional in design and employed both quantitative and qualitative data collection methods. The quantitative survey was conducted among 540 households (household heads being participants) while the qualitative component involved 4 focus group discussions among community health workers (CHWs). Chi-square test was used to compare quantitative results from the evaluation with those of the baseline while thematic analysis was employed for qualitative data. Results There was a statistically significant positive change in malaria prevention practices in the evaluation compared with the baseline regarding indoor residual spraying (χ2 = 7.9, p = 0.019), mosquito screening of windows and ventilators (χ2 = 62.3, p = 0.001), and closing windows of houses before 6:00 pm (χ2 = 60.2, p < 0.001). The CHWs trained during the project were found to be highly knowledgeable on the various malaria prevention methods in the integrated approach, and continued to promote their use in the community. Conclusion Findings of the impact evaluation give promise that utilisation of integrated malaria prevention can be enhanced if use of multiple methods is promoted in communities.
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Laboudi M, Sahibi H, Elabandouni M, Nhammi H, Ait Hamou S, Sadak A. A review of cutaneous leishmaniasis in Morocco: A vertical analysisto determine appropriate interventions for control and prevention. Acta Trop 2018; 187:275-283. [PMID: 30056074 DOI: 10.1016/j.actatropica.2018.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 11/24/2022]
Abstract
Leishmaniasis is considered one of the most neglected diseases worldwide. In Morocco, cutaneous leishmaniasis is an important public health problem. Leishmania major and Leishmania tropica are the two major species in this country. Despite all efforts, monitoring and control of the cutaneous leishmaniasis is still challenging. We used for the first time a vertical analysis of the control of cutaneous leishmaniasis in Morocco from the document review and publications. This analysis allowed us to develop an epidemiological model that emphasized key possible interventions. No evaluation studies of these interventions in Morocco were done. Global Evidence underline the effectiveness of preventive interventions produced in integrate inter-sectorial strategy framework (e.g use of insecticide-treated bednets, indoor residual spraying and rodents' control) rather than treatments such as based thermotherapy, cryotherapy, photodynamic therapy, CO2 laser and paromomycin. Therefore, integrated vector management control (IVMC) with communityc participation is recommended as effective strategy. Strengthening of the IVMC with community involvement are necessary conditions to improve the program of cutaneous leishmaniasis and prevent epidemic foci appearance.
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15
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Swanson M, Ibrahim S, Blat C, Oketch S, Olwanda E, Maloba M, Huchko MJ. Evaluating a community-based cervical cancer screening strategy in Western Kenya: a descriptive study. BMC WOMENS HEALTH 2018; 18:116. [PMID: 29970063 PMCID: PMC6029075 DOI: 10.1186/s12905-018-0586-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 06/05/2018] [Indexed: 12/31/2022]
Abstract
Background The incidence of cervical cancer in Kenya is among the highest in the world. Few Kenyan women are able to access screening, thus fueling the high cervical cancer burden. Self-collected human papilloma Virus (HPV) tests, administered during community-health campaigns in rural areas may be a way to expand access to screening. Methods In December 2015, we carried out a four-day community health campaign (CHC) to educate participants about cervical cancer prevention and offer self-administered HPV screening. Community enumeration, outreach and mobilization preceded the CHC. Samples were sent to Migori County Hospital for HPV DNA testing using careHPV Test Kits. Women were notified of results through their choice of short message service (SMS), phone call, home visit or clinic visit. HPV positive women were referred for cryotherapy following a screen-and-treat strategy. Results Door-to-door enumeration identified approximately 870 eligible women in Ngodhe Community in Migori County. Among the 267 women attending the campaign, 255 women enrolled and collected samples: 243 tests were successfully resulted and 12 were indeterminate. Of the 243 resulted tests, 47 (19%) were positive for HPV, with young age being the only significant predictor of positivity. In multivariate analysis, each additional year of age conferred about a 4% decrease in the odds of testing positive (95% CI 0.1 to 7%, p = 0.046). Just over three-quarters of all women (195/255), were notified of their results. Those who were unable to be reached were more likely to prefer receiving results from clinic (54/60, 90%) and were less likely to have mobile phones (24/60, 73%). Although 76% of HPV positive women were notified of their results, just half (51%) of those testing positive presented for treatment. HPV positive women who successfully accessed the treatment facility did not differ from their non-presenting counterparts by demographics, health history, desired route of notification or access to a mobile phone. Conclusion Nearly a third of eligible women in Ngodhe Community attended the CHC and were screened for cervical cancer. Nearly all women who attended the CHC underwent cervical cancer screening by self-collected HPV tests. Three-quarters of all participants received results, but just half of HPV positive participants presented for treatment in a timely fashion, suggesting that linkage to treatment remains a major challenge. Trial registration NCT02124252, Registered 25 April 2014.
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Affiliation(s)
- Megan Swanson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, Mission Hall, 7th Floor, Room 7444, Box 0132, 550 16th St, San Francisco, CA, 94158, USA.
| | - Saduma Ibrahim
- Research care and Training Programme/FACES NGO, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cinthia Blat
- Department of Obstetrics and Gynecology, UCSF, San Francisco, USA
| | - Sandra Oketch
- Research care and Training Programme/FACES NGO, Kenya Medical Research Institute, Nairobi, Kenya
| | - Easter Olwanda
- Research care and Training Programme/FACES NGO, Kenya Medical Research Institute, Nairobi, Kenya
| | - May Maloba
- Research care and Training Programme/FACES NGO, Kenya Medical Research Institute, Nairobi, Kenya
| | - Megan J Huchko
- Duke Department of Obstetrics and Gynecology, Global Health Institute, Durham, USA
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16
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Shen J, Olwanda E, Kahn JG, Huchko MJ. Cost of HPV screening at community health campaigns (CHCs) and health clinics in rural Kenya. BMC Health Serv Res 2018; 18:378. [PMID: 29801496 PMCID: PMC5970469 DOI: 10.1186/s12913-018-3195-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is the most frequent neoplasm among Kenyan women, with 4800 diagnoses and 2400 deaths per year. One reason is an extremely low rate of screening through pap smears, at 13.8% in 2014. Knowing the costs of screening will help planners and policymakers design, implement, and scale programs. Methods We conducted HPV-based cervical cancer screening via self-collection in 12 communities in rural Migori County, Kenya. Six communities were randomized to community health campaigns (CHCs), and six to screening at government clinics. All HPV-positive women were referred for cryotherapy at Migori County Hospital. We prospectively estimated direct costs from the health system perspective, using micro-costing methods. Cost data were extracted from expenditure records, staff interviews, and time and motion logs. Total costs per woman screening included three activities: outreach, HPV-based screening, and notification. Types of inputs include personnel, recurrent goods, capital goods, and services. We costed potential changes to implementation for scaling. Results From January to September 2016, 2899 women were screened in CHCs and 2042 in clinics. Each CHC lasted for 30 working days, 10 days each for outreach, screening, and notification. The mean cost per woman screened was $25.00 for CHCs [median: $25.09; Range: $22.06-30.21] and $29.56 for clinics [$28.90; $25.27-37.08]. Clinics had higher costs than CHCs for personnel ($14.27 vs. $11.26) and capital ($5.55 vs. $2.80). Screening costs were higher for clinics at $21.84, compared to $17.48 for CHCs. In contrast, CHCs had higher outreach costs ($3.34 vs. $0.17). After modeling a reduction in staffing, clinic per-screening costs ($25.69) were approximately equivalent to CHCs. Conclusions HPV-based cervical cancer screening through community health campaigns achieved lower costs per woman screened, compared to screening at clinics. Periodic high-volume CHCs appear to be a viable low-cost strategy for implementing cervical cancer screening. Electronic supplementary material The online version of this article (10.1186/s12913-018-3195-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Shen
- Philip R. Lee Institute for Health Policy Studies, University of California, 3333 California Street Suite 265, Box 0936, San Francisco, CA, 94118, USA.
| | - Easter Olwanda
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - James G Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California, 3333 California Street Suite 265, Box 0936, San Francisco, CA, 94118, USA
| | - Megan J Huchko
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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Johns B, Yihdego YY, Kolyada L, Dengela D, Chibsa S, Dissanayake G, George K, Taffese HS, Lucas B. Indoor Residual Spraying Delivery Models to Prevent Malaria: Comparison of Community- and District-Based Approaches in Ethiopia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2016; 4:529-541. [PMID: 27965266 PMCID: PMC5199172 DOI: 10.9745/ghsp-d-16-00165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/21/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND Indoor residual spraying (IRS) for malaria prevention has traditionally been implemented in Ethiopia by the district health office with technical and operational inputs from regional, zonal, and central health offices. The United States President's Malaria Initiative (PMI) in collaboration with the Government of Ethiopia tested the effectiveness and efficiency of integrating IRS into the government-funded community-based rural health services program. METHODS Between 2012 and 2014, PMI conducted a mixed-methods study in 11 districts of Oromia region to compare district-based IRS (DB IRS) and community-based IRS (CB IRS) models. In the DB IRS model, each district included 2 centrally located operational sites where spray teams camped during the IRS campaign and from which they traveled to the villages to conduct spraying. In the CB IRS model, spray team members were hired from the communities in which they operated, thus eliminating the need for transport and camping facilities. The study team evaluated spray coverage, the quality of spraying, compliance with environmental and safety standards, and cost and performance efficiency. RESULTS The average number of eligible structures found and sprayed in the CB IRS districts increased by 19.6% and 20.3%, respectively, between 2012 (before CB IRS) and 2013 (during CB IRS). Between 2013 and 2014, the numbers increased by about 14%. In contrast, in the DB IRS districts the number of eligible structures found increased by only 8.1% between 2012 and 2013 and by 0.4% between 2013 and 2014. The quality of CB IRS operations was good and comparable to that in the DB IRS model, according to wall bioassay tests. Some compliance issues in the first year of CB IRS implementation were corrected in the second year, bringing compliance up to the level of the DB IRS model. The CB IRS model had, on average, higher amortized costs per district than the DB IRS model but lower unit costs per structure sprayed and per person protected because the community-based model found and sprayed more structures. CONCLUSION Established community-based service delivery systems can be adapted to include a seasonal IRS campaign alongside the community-based health workers' routine activities to improve performance efficiency. Further modifications of the community-based IRS model may reduce the total cost of the intervention and increase its financial sustainability.
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Affiliation(s)
- Benjamin Johns
- Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Bethesda, MD, USA
| | - Yemane Yeebiyo Yihdego
- Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Addis Ababa, Ethiopia
| | - Lena Kolyada
- Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Bethesda, MD, USA.
| | - Dereje Dengela
- Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Bethesda, MD, USA
| | - Sheleme Chibsa
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Addis Ababa, Ethiopia
| | - Gunawardena Dissanayake
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Addis Ababa, Ethiopia
| | - Kristen George
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Bureau for Global Health, Office of Health, Infectious Disease & Nutrition, Arlington, VA, USA
| | | | - Bradford Lucas
- Abt Associates, Inc., The President's Malaria Initiative Africa Indoor Residual Spraying Project, Bethesda, MD, USA
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Krezanoski PJ. Delivering insecticide-treated nets for malaria prevention: innovative strategies. Res Rep Trop Med 2016; 7:39-47. [PMID: 30050338 PMCID: PMC6028060 DOI: 10.2147/rrtm.s83173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The wide-scale adoption of insecticide-treated nets (ITNs) has led to significant reductions in malaria morbidity and mortality worldwide. Delivery of ITNs to the 3.2 billion people at risk of malaria requires multiple steps in diverse settings. The effectiveness of the delivery of ITNs in order to prevent malaria relies on activities that include ITN manufacturing and design, integration into national and international malaria prevention policies, supplying and distributing ITNs to households and individuals, and, finally, programs focused on spurring demand for and use of ITNs by individuals at risk. This paper reviews some recent innovative strategies for ITN delivery across these four domains, places these innovations within the context of the history of ITN deployment, and identifies opportunities to further improve the effectiveness of this ubiquitous public health tool.
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Affiliation(s)
- Paul J Krezanoski
- Department of Medicine.,Department of Pediatrics, Massachusetts General Hospital.,Medicine and Pedatrics, Harvard Medical School, Boston, MA, USA
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Dawaki S, Al-Mekhlafi HM, Ithoi I, Ibrahim J, Atroosh WM, Abdulsalam AM, Sady H, Elyana FN, Adamu AU, Yelwa SI, Ahmed A, Al-Areeqi MA, Subramaniam LR, Nasr NA, Lau YL. Is Nigeria winning the battle against malaria? Prevalence, risk factors and KAP assessment among Hausa communities in Kano State. Malar J 2016; 15:351. [PMID: 27392040 PMCID: PMC4938925 DOI: 10.1186/s12936-016-1394-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is one of the most severe global public health problems worldwide, particularly in Africa, where Nigeria has the greatest number of malaria cases. This community-based study was designed to investigate the prevalence and risk factors of malaria and to evaluate the knowledge, attitudes, and practices (KAP) regarding malaria among rural Hausa communities in Kano State, Nigeria. METHODS A cross-sectional community-based study was conducted on 551 participants from five local government areas in Kano State. Blood samples were collected and examined for the presence of Plasmodium species by rapid diagnostic test (RDT), Giemsa-stained thin and thick blood films, and PCR. Moreover, demographic, socioeconomic, and environmental information as well as KAP data were collected using a pre-tested questionnaire. RESULTS A total of 334 (60.6 %) participants were found positive for Plasmodium falciparum. The prevalence differed significantly by age group (p < 0.01), but not by gender or location. A multivariate analysis showed that malaria was associated significantly with being aged 12 years or older, having a low household family income, not using insecticide treated nets (ITNs), and having no toilets in the house. Overall, 95.6 % of the respondents had prior knowledge about malaria, and 79.7, 87.6 and 95.7 % of them knew about the transmission, symptoms, and prevention of malaria, respectively. The majority (93.4 %) of the respondents considered malaria a serious disease. Although 79.5 % of the respondents had at least one ITN in their household, utilization rate of ITNs was 49.5 %. Significant associations between the respondents' knowledge concerning malaria and their age, gender, education, and household monthly income were reported. CONCLUSIONS Malaria is still highly prevalent among rural Hausa communities in Nigeria. Despite high levels of knowledge and attitudes in the study area, significant gaps persist in appropriate preventive practices, particularly the use of ITNs. Innovative and Integrated control measures to reduce the burden of malaria should be identified and implemented in these communities. Community mobilization and health education regarding the importance of using ITNs to prevent malaria and save lives should be considered.
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Affiliation(s)
- Salwa Dawaki
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,School of Health Technology, Club Road, Nassarawa, Kano, Kano State, Nigeria
| | - Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Endemic and Tropical Diseases Unit, Medical Research Center, Jazan University, Jazan, Kingdom of Saudi Arabia. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Init Ithoi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Jamaiah Ibrahim
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Awatif M Abdulsalam
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hany Sady
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Fatin Nur Elyana
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ado U Adamu
- North West Zonal Tuberculosis Reference Laboratory, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Saadatu I Yelwa
- Rabi'u Musa Kwankwaso College of Advanced and Remedial Studies, Tudun Wada, Kano State, Nigeria
| | - Abdulhamid Ahmed
- Department of Biology, Faculty of Natural and Applied Sciences, Umaru Musa Yar'adua University, Katsina, Katsina State, Nigeria
| | - Mona A Al-Areeqi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Lahvanya R Subramaniam
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nabil A Nasr
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Tiffany A, Moundekeno FP, Traoré A, Haile M, Sterk E, Guilavogui T, Genton B, Serafini M, Grais RF. Encouraging impact following 2.5 years of reinforced malaria control interventions in a hyperendemic region of the Republic of Guinea. Malar J 2016; 15:298. [PMID: 27234972 PMCID: PMC4884386 DOI: 10.1186/s12936-016-1353-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is one of the principal causes of morbidity and mortality in the Republic of Guinea, particularly in the highly endemic regions. To assist in malaria control efforts, a multi-component malaria control intervention was implemented in the hyperendemic region of Guéckédou Prefecture. The coverage of the intervention and its impact on malaria parasite prevalence were assessed. METHODS Five cross-sectional surveys using cluster-based sampling and stratified by area were conducted from 2011 to 2013 in three sous-préfectures of Guéckédou Préfecture that received the intervention: Guéckédou City, Tékoulo and Guendembou in addition to one comparison sous-préfecture that did not receive the intervention, Koundou. Surveys were repeated every 6 months, corresponding with the dry and rainy seasons. Rapid diagnostic tests (RDT) were used to diagnose malaria infection. In each selected household, bed net use and ownership were assessed. RESULTS A total of 35,123 individuals participated in the surveys. Malaria parasite prevalence declined in all intervention sous-préfectures from 2011 to 2013 (56.4-45.9 % in Guéckédou City, 64.9-54.1 % in Tékoulo and 69.4-56.9 % in Guendembou) while increasing in the comparison sous-préfecture (64.5-69 %). It was consistently higher in children 5-14 years of age followed by those 1-59 months and ≥15 years. Indicators of intervention coverage, the proportion of households reporting ownership of at least one bed net and the proportion of survey participants with fever who received treatment from a health facility or community health worker also increased significantly in the intervention areas. CONCLUSIONS Implementation of the multi-component malaria control intervention significantly reduced the prevalence of malaria in the sous-préfectures of intervention while also increasing the coverage of bed nets. However, malaria prevalence remains unacceptably high and disproportionately affects children <15 years of age. In such situations additional vector control interventions and age specific interventions should be considered.
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Affiliation(s)
| | | | | | | | | | | | - Blaise Genton
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Infectious Disease Service and Department of Ambulatory Care, University Hospital Lausanne, Lausanne, Switzerland
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21
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Zhou SS, Zhang SS, Zhang L, Rietveld AEC, Ramsay AR, Zachariah R, Bissell K, Van den Bergh R, Xia ZG, Zhou XN, Cibulskis RE. China's 1-3-7 surveillance and response strategy for malaria elimination: Is case reporting, investigation and foci response happening according to plan? Infect Dis Poverty 2015; 4:55. [PMID: 26654106 PMCID: PMC4674909 DOI: 10.1186/s40249-015-0089-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/25/2015] [Indexed: 12/21/2022] Open
Abstract
Background The China’s 1-3-7 strategy was initiated and extensively adopted in different types of counties (geographic regions) for reporting of malaria cases within 1 day, their confirmation and investigation within 3 days, and the appropriate public health response to prevent further transmission within 7 days. Assessing the level of compliance to the 1-3-7 strategy at the county level is a first step towards determining whether the surveillance and response strategy is happening according to plan. This study assessed if the time-bound targets of the 1-3-7 strategy were being sustained over time. Such information would be useful to improve implementation of the 1-3-7 strategy in China. Methods This cross-sectional study involved country-wide programmatic data for the period January 1st 2013 to June 30th 2014. Data variables were extracted from the national malaria information system and included socio-demographic information, type of county, date of diagnosis, date of reporting, date of case investigation, case classification (indigenous, or imported, or unknown), focus investigation, date of reactive case detection (RACD), and date of indoor residual spraying (IRS). Summary statistics and proportions were used and comparisons between groups were assessed using the chi-square test. Level of significance was set at a P-value ≤ 0.05. Results Of a total of 5,688 malaria cases from 731 counties, there were 55 (1 %) indigenous cases (only in Type 1 and Type 2 counties) and 5,633 (99 %) imported cases from all types of counties. There was no delay in reporting malaria cases by type of county. In terms of case investigation, 97.5 % cases were investigated within 3 days with the proportion of delays (1.5 %) in type 2 counties, being significantly lower than type 1 counties (4.1 %). Regarding active foci, 96.4 % were treated by RACD and/or IRS. Conclusions The performance of 1-3-7 strategy was encouraging but identified some challenges that if addressed can further improve implementation. Electronic supplementary material The online version of this article (doi:10.1186/s40249-015-0089-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shui-Sen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Shao-Sen Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Li Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Aafje E C Rietveld
- Global Malaria Programme, World Health Organization, 20 Avenue Appia, CH-1211, Geneva, 27, Switzerland.
| | - Andrew R Ramsay
- Special Programme for Research and Training in Tropical Diseases (TDR), 20 Avenue Appia, CH-1211, Geneva, 27, Switzerland.
| | - Rony Zachariah
- Médecins Sans Frontieres, Brussels Operational Centre, Luxembourg, Luxembourg.
| | - Karen Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France.
| | | | - Zhi-Gui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Richard E Cibulskis
- Global Malaria Programme, World Health Organization, 20 Avenue Appia, CH-1211, Geneva, 27, Switzerland.
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22
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Feng J, Xia ZG, Vong S, Yang WZ, Zhou SS, Xiao N. Preparedness for malaria resurgence in China: case study on imported cases in 2000-2012. ADVANCES IN PARASITOLOGY 2015; 86:231-65. [PMID: 25476887 DOI: 10.1016/b978-0-12-800869-0.00009-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Malaria is the most important parasitic protozoan infection that has caused serious threats to human health globally. China has had success in reducing the morbidity and mortality of malaria to the lowest level through sustained and large-scale interventions. Although the total number of malaria cases declined gradually, the burden of the imported malaria cases mainly from Southeast Asian and African countries has increased substantially since 2000, posing a severe threat to public health in China. This review explores and analyses the epidemiological characteristics of the imported malaria based on data from 2000 to 2012, in order to provide theoretical bases and insights into effective prevention, avoid the resurgence of malaria in malaria-susceptible areas and develop appropriate strategies to protect people's health in China. This review also intends to offer the useful information of innovative approaches and tools that are required for malaria elimination in various settings.
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Affiliation(s)
- Jun Feng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Shanghai, People's Republic of China
| | - Zhi-Gui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Shanghai, People's Republic of China
| | - Sirenda Vong
- World Health Organization, China Representative Office, Beijing, People's Republic of China
| | - Wei-Zhong Yang
- Chinese Preventive Medicine Association, Beijing, People's Republic of China; Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shui-Sen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Shanghai, People's Republic of China
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Shanghai, People's Republic of China
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23
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Bhutta ZA, Salam RA, Das JK, Lassi ZS. Tackling the existing burden of infectious diseases in the developing world: existing gaps and the way forward. Infect Dis Poverty 2014; 3:28. [PMID: 25105015 PMCID: PMC4124963 DOI: 10.1186/2049-9957-3-28] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 06/30/2014] [Indexed: 11/26/2022] Open
Abstract
This series evaluates the effectiveness of community-based interventions (CBIs) to prevent and control infectious diseases of poverty (IDoP). Evidence from our reviews suggests that CBIs and school-based delivery platforms are effective in averting risk behaviors and reducing the disease burden. Co-implementation of interventions through existing community-based programs including immunization campaigns, antenatal care and maternal and child health programs have the potential to scale-up interventions for IDoP. Future research should focus on the process of developing and implementing efficient community-based programs through a comprehensive approach, and to gauge the effectiveness of various existing delivery models in order to improve morbidity and mortality outcomes.
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Affiliation(s)
- Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan ; Center for Global Child Health Hospital for Sick Children, Toronto, Canada
| | - Rehana A Salam
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
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24
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Qian YJ, Zhang L, Xia ZG, Vong S, Yang WZ, Wang DQ, Xiao N. Preparation for malaria resurgence in China: approach in risk assessment and rapid response. ADVANCES IN PARASITOLOGY 2014; 86:267-88. [PMID: 25476888 DOI: 10.1016/b978-0-12-800869-0.00010-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
With the shrinking of indigenous malaria cases and endemic areas in the People's Republic of China (P.R. China), imported malaria predominates over all reported cases accounting for more than 90% of the total. On the way to eliminate malaria, prompt detection and rapid response to the imported cases are crucial for the prevention of secondary transmission in previous endemic areas. Through a comprehensive literature review, this chapter aims to identify risk determinants of potential local transmission caused by the imported malaria cases and discusses gaps to be addressed to reach the elimination goal by 2020. Current main gaps with respect to dealing with potential malaria resurgence in P.R. China include lack of cross-sectoral cooperation, lack of rapid response and risk assessment, poor public awareness, and inadequate research and development in the national malaria elimination programme.
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