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Vere M, ten Ham-Baloyi W, Melariri PE. Effects of paediatric schistosomiasis control programmes in sub-Saharan Africa: A systematic review. PLoS One 2024; 19:e0301464. [PMID: 38696510 PMCID: PMC11065241 DOI: 10.1371/journal.pone.0301464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/17/2024] [Indexed: 05/04/2024] Open
Abstract
Preventive chemotherapy by mass drug administration is globally recommended as the primary method of reaching the elimination of schistosomiasis, especially in the high risk-paediatric population. This systematic review provides a summary of the effects of paediatric schistosomiasis control programs on eliminating schistosomiasis in sub-Saharan Africa. A systematic search was conducted in PubMed, EBSCOhost, and other databases to obtain studies regarding the effects of paediatric schistosomiasis control programmes in sub-Saharan Africa. 3455 studies were screened for eligibility, included articles reported on both paediatrics control programmes and schistosomiasis, and articles were excluded when they did not report on schistosomiasis control programmes in paediatrics exclusively. 40 selected studies were critically appraised using the JBI critical appraisal tools for relevance and 30 studies were included in the study. An in-depth quantitative descriptive analysis was conducted, and a comprehensive narrative summary explained the results within the scope of the review questions. The results show that despite preventive chemotherapy lowering schistosomiasis prevalence, chances of re-infection are high in endemic areas. Preventive chemotherapy without complementary interventions including safe water provision and proper sanitation, snail control and health education on the aetiology of schistosomiasis, transmission pattern and control practices might not eliminate schistosomiasis.
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Affiliation(s)
- Maryline Vere
- Faculty of Health Sciences, Department of Environmental Health, Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa
| | - Wilma ten Ham-Baloyi
- Faculty of Health Sciences, Department of Environmental Health, Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa
- Faculty of Health Sciences, Department of Nursing Science, Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa
| | - Paula Ezinne Melariri
- Faculty of Health Sciences, Department of Nursing Science, Nelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa
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Forson AO, Awuah RB, Mohammed AR, Owusu-Asenso CM, Atakora SB, Akosah-Brempong G, Abdulai A, Sraku IK, Dhikrullahi SB, Attah SK, Afrane YA. Perceptions of the roles, impact, challenges and needs of community drug distributors in the control and elimination of neglected tropical diseases in difficult-to-access communities in Ghana. BMC Infect Dis 2023; 23:460. [PMID: 37430222 DOI: 10.1186/s12879-023-08437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/01/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION The success of mass drug administration (MDA) campaigns to control and eliminate neglected tropical diseases (NTDs) in Ghana depends, to a large extent, on the essential role community drug distributors (CDDs) play. This study aimed to investigate community's perceptions of CDDs' roles, impact of CDDs' work, challenges faced by CDDs, and views on resources required to enhance CDDs' work to sustain MDA campaigns. METHODS A cross-sectional qualitative study employing the use of focus group discussions (FGDs) with community members and CDDs in selected NTD endemic communities together with individual interviews with district health officers (DHOs) was conducted. We interviewed 104 people aged 18 and over, purposively selected, through eight individual interviews, and 16 focus group discussions. RESULTS Participants in the community FGDs noted that health education and the distribution of drugs were the main roles of CDDs. Participants also perceived that the work of CDDs had prevented the onset of NTDs, treated symptoms of NTDs, and generally reduced the incidence of infections. In the interviews with CDDs and DHOs, lack of cooperation/non-compliance by community members, demands by community members, lack of working resources and low financial motivation were mentioned as the main challenges to the work of CDDs. Moreover, the provision of logistics and financial motivation for CDDs were identified as factors that will enhance their work. CONCLUSIONS Incorporating more attractive schemes will incentivise CDDs to improve output. Addressing the challenges highlighted is an important step for the work of CDDS to be effective in controlling NTDs in difficult-to-access communities in Ghana.
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Affiliation(s)
- Akua Obeng Forson
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
- Department of Medical Laboratory Science, School of Biomedical and Allied Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - Raphael Baffour Awuah
- Regional Institute for Population Studies (RIPS), University of Ghana, Legon, Accra, Ghana
| | - Abdul Rahim Mohammed
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
| | - Christopher Mfum Owusu-Asenso
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
| | - Sefa Bonsu Atakora
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
| | - Gabriel Akosah-Brempong
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
| | - Anisa Abdulai
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
| | - Isaac Kwame Sraku
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
| | - Shittu B Dhikrullahi
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
| | - Simon K Attah
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana
| | - Yaw Asare Afrane
- Centre for Vector-borne Diseases Research, Department of Medical Microbiology, Medical School, University of Ghana, University of Ghana, Korle-Bu, Accra, Ghana.
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Forson AO, Awuah RB, Mohammed AR, Owusu-Asenso CM, Atakora SB, Akosah-Brempong G, Abdulai A, Sraku IK, Dhikrullahi SB, Attah SK, Afrane YA. Perceptions of the roles, impact, challenges and needs of community drug distributors in the control and elimination of neglected tropical diseases in difficult-to-access communities in Ghana. RESEARCH SQUARE 2023:rs.3.rs-2640312. [PMID: 36993399 PMCID: PMC10055524 DOI: 10.21203/rs.3.rs-2640312/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The success of mass drug administration (MDA) campaigns to control and eliminate neglected tropical diseases (NTDs) in Ghana depends, to a large extent, on the essential role community drug distributors (CDDs) play. This study aimed to investigate community's perceptions of CDDs' roles, impact of CDDs' work, challenges faced by CDDs and views on resources required to enhance CDDs' work to sustain MDA campaigns. Methods : A cross-sectional qualitative study employing the use of focus group discussions (FGDs) with community members and CDDs in selected NTD endemic communities together with individual interviews with district health officers (DHOs)was conducted. We interviewed 104 people aged 18 and over, purposively selected, through eight individual interviews, and 16 focus group discussions. Results : Participants in the community FGDs noted that health education and distribution of drugs were the main roles of CDDs. Participants also perceived that the work of CDDs had prevented the onset of NTDs, treated symptoms of NTDs and generally reduced the incidence of infections. In the interviews with CDDs and DHOs, lack of cooperation/non-compliance by community members, demands by community members, lack of working resources and low financial motivation were mentioned as the main challenges to the work of CDDs. Moreover, provision of logistics and financial motivation for CDDs were identified as factors that will enhance their work. Conclusions : Incorporating more attractive schemes shall incentivise CDDs to improve output. Addressing the challenges highlighted is an important step for the work of CDDS to be effective in controlling NTDs in difficult-to-access communities in Ghana.
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Mogaji HO, Okoh HI, Lawal AM, Ojo KH, Marcus AJ, Aaron NO, Adeleye DR, Olamiju FO, Ekpo UF. A Post-Lockdown Assessment of Albendazole Treatment Coverage in Mass Drug Administration Campaigns Implemented Before and During COVID-19 Pandemic in Ekiti, Southwest Nigeria. Int J Public Health 2023; 68:1605510. [PMID: 36846154 PMCID: PMC9948738 DOI: 10.3389/ijph.2023.1605510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
Objective: This study assessed the coverage of albendazole (ALB) in mass drug administration (MDA) programs implemented before (2019) and during the (2020 and 2021) COVID-19 pandemic in Ekiti State, Nigeria. Methods: Standardized questionnaires were administered to 1,127 children across three peri-urban communities to ascertain if they received and swallowed ALB across the years. Reasons, why ALB was not received, were documented and analyzed in SPSS. 20.0. Results: In 2019, the medicine reach was between 42.2%-57.8%, however, during the pandemic, the reach significantly reduced to 12.3%-18.6%, and increased to 28.5%-35.2% in 2021 (p < 0.000). About 19.6%-27.2% of the participants have missed 1 MDA, while 26.9%-37.8% and 22.4%-32.8% have missed 2 and 3 MDAs, respectively. The majority who did not receive ALB (60.8%-75%) claimed drug distributors never came, while about 14.9%-20.3% mentioned they did not hear about MDA. However, individual compliance towards swallowing was above 94% across the study years (p < 0.00). Conclusion: These results highlight the need to explore the perceptions of those who have consistently missed MDAs, and also understand the health-system-related issues including those imposed by the pandemic affecting MDA.
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Affiliation(s)
- Hammed O. Mogaji
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria,*Correspondence: Hammed O. Mogaji,
| | - Hilary I. Okoh
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Abiodun M. Lawal
- Clinical Psychology Unit, Department of Psychology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Kayode H. Ojo
- Neglected Tropical Diseases Unit, Ekiti State Primary Healthcare and Development Agency, Ado Ekiti, Nigeria
| | | | - Nwana O. Aaron
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Damilola R. Adeleye
- Clinical Psychology Unit, Department of Psychology, Federal University Oye-Ekiti, Oye, Nigeria
| | | | - Uwem F. Ekpo
- Parasitology and Epidemiology Unit, Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Abeokuta, Nigeria,Bioscience Research Programme, Institute of Food Security, Environmental Resource and Agricultural Research (IFSERAR), Federal University of Agriculture, Abeokuta, Nigeria
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Karutu C, Schultz L, Waltz J, Campbell SJ, Kamara K, Yotebieng K, Gouvras A, Rollinson D, Bundy DAP. A coordinated response to the needs of the learner: How deworming and school meals together will contribute to the global recovery from the COVID-19 pandemic. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.998276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gwayi-Chore MC, Aruldas K, Avokpaho E, Chirambo CM, Kaliappan SP, Houngbégnon P, Togbevi CI, Chabi F, Nindi P, Simwanza J, Johnson J, Miech EJ, Kalua K, Ibikounlé M, Ajjampur SSR, Weiner BJ, Walson JL, Means AR. Defining optimal implementation packages for delivering community-wide mass drug administration for soil-transmitted helminths with high coverage. BMC Health Serv Res 2022; 22:792. [PMID: 35717193 PMCID: PMC9206125 DOI: 10.1186/s12913-022-08080-5] [Citation(s) in RCA: 6] [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: 02/10/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recent evidence suggests that community-wide mass drug administration (MDA) may interrupt the transmission of soil-transmitted helminths (STH), a group of intestinal worms that infect 1.5 billion individuals globally. Although current operational guidelines provide best practices for effective MDA delivery, they do not describe which activities are most essential for achieving high coverage or how they work together to produce effective intervention delivery. We aimed to identify the various packages of influential intervention delivery activities that result in high coverage of community-wide MDA for STH in Benin, India, and Malawi. METHODS We applied coincidence analysis (CNA), a novel cross-case analytical method, to process mapping data as part of the implementation science research of the DeWorm3 Project, a Hybrid Type 1 cluster randomized controlled trial assessing the feasibility of interrupting the transmission of STH using bi-annual community-wide MDA in Benin, India, and Malawi. Our analysis aimed to identify any necessary and/or sufficient combinations of intervention delivery activities (i.e., implementation pathways) that resulted in high MDA coverage. Activities were related to drug supply chain, implementer training, community sensitization strategy, intervention duration, and implementation context. We used pooled implementation data from three sites and six intervention rounds, with study clusters serving as analytical cases (N = 360). Secondary analyses assessed differences in pathways across sites and over intervention rounds. RESULTS Across all three sites and six intervention rounds, efficient duration of MDA delivery (within ten days) singularly emerged as a common and fundamental component for achieving high MDA coverage when combined with other particular activities, including a conducive implementation context, early arrival of albendazole before the planned start of MDA, or a flexible community sensitization strategy. No individual activity proved sufficient by itself for producing high MDA coverage. We observed four possible overall models that could explain effective MDA delivery strategies, all which included efficient duration of MDA delivery as an integral component. CONCLUSION Efficient duration of MDA delivery uniquely stood out as a highly influential implementation activity for producing high coverage of community-wide MDA for STH. Effective MDA delivery can be achieved with flexible implementation strategies that include various combinations of influential intervention components.
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Affiliation(s)
- Marie-Claire Gwayi-Chore
- Department of Global Health, University of Washington, Seattle, USA.
- The DeWorm3 Project, University of Washington, Seattle, WA, USA.
| | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | | | | | | | | | - Félicien Chabi
- Institut de Recherche Clinique du Benin, Abomey-Calavi, Benin
| | - Providence Nindi
- Blantyre Institute for Community Outreach (BICO), Lions Sight First Eye Hospital, Blantyre, Malawi
| | - James Simwanza
- Blantyre Institute for Community Outreach (BICO), Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Jabaselvi Johnson
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Edward J Miech
- Center for Health Services Research, Regenstrief Institute, Indianapolis, USA
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach (BICO), Lions Sight First Eye Hospital, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Moudachirou Ibikounlé
- Institut de Recherche Clinique du Benin, Abomey-Calavi, Benin
- Centre de Recherche pour la Lutte Contre les Maladies Infectieuses Tropicales, Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Sitara S R Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, USA
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, USA
- The DeWorm3 Project, University of Washington, Seattle, WA, USA
- Departments of Medicine, Pediatrics, & Epidemiology, University of Washington, Seattle, USA
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, USA
- The DeWorm3 Project, University of Washington, Seattle, WA, USA
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Avokpaho E, Lawrence S, Roll A, Titus A, Jacob Y, Puthupalayam Kaliappan S, Gwayi-Chore MC, Chabi F, Togbevi CI, Elijan AB, Nindi P, Walson JL, Ajjampur SSR, Ibikounle M, Kalua K, Aruldas K, Means AR. It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth. BMJ Open 2022; 12:e061682. [PMID: 35701056 PMCID: PMC9198697 DOI: 10.1136/bmjopen-2022-061682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Current soil-transmitted helminth (STH) morbidity control guidelines primarily target deworming of preschool and school-age children. Emerging evidence suggests that community-wide mass drug administration (cMDA) may interrupt STH transmission. However, the success of such programmes depends on achieving high treatment coverage and uptake. This formative analysis was conducted to evaluate the implementation climate for cMDA and to determine barriers and facilitators to launch. SETTINGS Prior to the launch of a cMDA trial in Benin, India and Malawi. PARTICIPANTS Community members (adult women and men, children, and local leaders), community drug distributors (CDDs) and health facility workers. DESIGN We conducted 48 focus group discussions (FGDs) with community members, 13 FGDs with CDDs and 5 FGDs with health facility workers in twelve randomly selected clusters across the three study countries. We used the Consolidated Framework for Implementation Research to guide the design of the interview guide and thematic analysis. RESULTS Across all three sites, aspects of the implementation climate that were facilitators to cMDA launch included: high community member demand for cMDA, integration of cMDA into existing vaccination campaigns and/or health services, and engagement with familiar health workers. Barriers to launching cMDA included mistrust towards medical interventions, fear of side effects and limited perceived need for interrupting STH transmission. We include specific recommendations from community members regarding cMDA distribution sites, personnel requirements, delivery timing and incentives, leaders to engage and methods for mobilising participants. CONCLUSIONS Prior to launching the cMDA programme as an alternative to school-based MDA, cMDA was found to be generally acceptable across diverse geographical and demographic settings. Community members, CDDs and health workers felt that engaging communities and tailoring programmes to the local context are critical for success. Potential barriers may be mitigated by identifying local concerns and addressing them via targeted community sensitisation prior to implementation. TRIAL REGISTRATION NUMBER NCT03014167; Pre-results.
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Affiliation(s)
| | - Sarah Lawrence
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Amy Roll
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, Seattle, Washington, USA
| | - Angelin Titus
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Yesudoss Jacob
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | | | - Marie Claire Gwayi-Chore
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, Seattle, Washington, USA
| | - Félicien Chabi
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | | | | | | | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, Seattle, Washington, USA
| | - Sitara Swarna Rao Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Moudachirou Ibikounle
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
- Centre de Recherche pour la lutte contre les Maladies Infectieuses Tropicales (CReMIT/TIDRC), Université d'Abomey-Calavi, Cotonou, Littoral, Benin
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, India
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, Seattle, Washington, USA
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Sangare M, Berthe A, Dolo H, Diabaté AF, Konipo FDN, Soumaoro L, Doumbia SS, Coulibaly ME, Diarra L, Sanogo Y, Atsou KM, Diallo AA, Coulibaly SY, Keita M, Doumbia S, Coulibaly YI. Evaluation of mass drug administration for schistosomiasis and soil-transmitted helminths in school-aged children in Bankass, Mali. Int J Infect Dis 2021; 112:196-201. [PMID: 34481965 DOI: 10.1016/j.ijid.2021.08.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In 2004, Mali implemented mass drug administration (MDA) aimed at controlling schistosomiasis and soil-transmitted helminths. Despite several rounds of MDA, the health district of Bankass reported low coverage (64.8%) for praziquantel and albendazole in 2017, meaning that this district was still facing challenges in accomplishing the targeted 75% coverage. This study aimed to explore the barriers and gaps that hindered MDA implementation in Bankass. METHODS A cross-sectional study was performed. Questionnaires were administrated to all school-aged children in randomly selected villages. Technical directors of community health centers and community drug distributors in the selected villages were included in the interviews. RESULTS A total of 2128 children and 52 health workers were interviewed. Coverage rates were 93.51% (1990/2128) for praziquantel and 95.25% (2027/2128) for albendazole. Among the untreated children, 31.63% (31/98) reported being unaware of the campaign and 26.53% (26/98) were unable to reach the distribution points. Most of the health workers suggested increasing incentives. CONCLUSION The data showed satisfactory coverage >90%, in contrast with lower rates initially reported by the district health information system. These results raise concerns about the reliability of programmatic data and highlight the importance of population-based surveys for the evaluation of control interventions.
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Affiliation(s)
- Moussa Sangare
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali.
| | - Adama Berthe
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Housseini Dolo
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Abdoul Fatao Diabaté
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Fatoumata Dite Nènè Konipo
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Lamine Soumaoro
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Salif Seriba Doumbia
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Michel Emmanuel Coulibaly
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Lamine Diarra
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Yacouba Sanogo
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Kueshivi Midodji Atsou
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Abdallah Amadou Diallo
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Siaka Yamoussa Coulibaly
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | | | - Seydou Doumbia
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Yaya Ibrahim Coulibaly
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali; Dermatology Hospital of Bamako, Bamako, Mali
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Tomokawa S, Miyake K, Takahashi K, Tomokawa A, Kokudo S, Ueno M, Kigawa M, Asakura T. Health screening system to ensure children's health and development in Japan. Pediatr Int 2021; 63:869-879. [PMID: 33864316 DOI: 10.1111/ped.14733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/28/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The establishment of health screening systems for children is important, however, such systems are not always well-established in developing countries. This study aimed to improve child health screening systems in developing countries by analyzing the factors that contribute to enabling continuous and proper screenings at various governmental levels in Japan. METHODS We reviewed the history of child health and development screening systems in Japan and examined factors that enabled their regular and nationwide implementation. RESULTS We identified the six enabling factors: (i) the existence of relevant laws and regulations in health and education systems for health checkups, (ii) mandated and detailed conditions for health checkups within both school and community health, (iii) the provision of guidelines and manuals for health checkups, (iv) a sufficient number of professionals to carry out the health checkups, (v) clear criteria for evaluating and interpreting the checkup results, and (vi) understanding among teachers, children, and guardians of the importance of health checkups. CONCLUSION We proposed the following six requirements to the governments in developing countries for establishing their own health screening programs: (i) a clear description of the need for regular and continuous health checkups in the relevant laws, regulations, and policies, (ii) mandate as essential activity and detailed requirements of the screening activities, (iii) provision of relevant manuals for health workers and teachers, (iv) provision of enough well-trained professionals and a training system, (v) studying growth and development curves for children, and (vi) promoting understanding among stakeholders about the importance of health checkups.
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Affiliation(s)
- Sachi Tomokawa
- Faculty of Education, Shinshu University, Nagano City, Nagano, Japan.,Japanese Consortium for Global School Health and Research, Okinawa, Japan
| | - Kimihiro Miyake
- Faculty of Education, Shinshu University, Nagano City, Nagano, Japan.,Faculty of Education, Tokyo Gakugei University, Koganei City, Tokyo, Japan
| | - Kenzo Takahashi
- Japanese Consortium for Global School Health and Research, Okinawa, Japan.,Graduate School of Public Health, Teikyo University, Itabashi-Ku, Tokyo, Japan
| | - Aya Tomokawa
- Matsuyama Shinonome College, Matsuyama City, Ehime, Japan
| | - Shohei Kokudo
- Japanese Consortium for Global School Health and Research, Okinawa, Japan.,Graduate School of Human Development and Environment, Kobe University, Kobe City, Hyogo, Japan
| | - Marie Ueno
- Faculty of Education, Shinshu University, Nagano City, Nagano, Japan
| | - Mika Kigawa
- Japanese Consortium for Global School Health and Research, Okinawa, Japan.,Kanagawa University of Human Services, Yokosuka City, Kanagawa, Japan
| | - Takashi Asakura
- Japanese Consortium for Global School Health and Research, Okinawa, Japan.,Faculty of Education, Tokyo Gakugei University, Koganei City, Tokyo, Japan
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Christine Masong M, Ozano K, Tagne MS, Tchoffo MN, Ngang S, Thomson R, Theobald S, Tchuenté LAT, Kouokam E. Achieving equity in UHC interventions: who is left behind by neglected tropical disease programmes in Cameroon? Glob Health Action 2021; 14:1886457. [PMID: 33641612 PMCID: PMC7919912 DOI: 10.1080/16549716.2021.1886457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: The UN's Sustainable Development Goals (SDGs) which pledge to leave no one behind for Universal health coverage (UHC) raise the importance of ensuring equitable health outcomes and healthcare delivery. As Neglected Tropical Diseases (NTDs) affect the most disadvantaged and hard to reach populations, they are considered a litmus test for Universal health coverage.Objective: Here, we assess the challenges of implementing Mass Drug Administrations (MDAs) for schistosomiasis prevention and control, in a context of expanded treatment where both community and school-based distribution were carried out, assessing which groups are missed and developing strategies to enhance equity.Methods: This is a qualitative study applying ethnographic observations, in-depth interviews (109) and focus group discussions (6) with key informants and other community members. Participants included community drug distributors, teachers, health workers, and implementing partners across four schistosomiasis endemic regions in Cameroon. Data collected were analysed thematically.Results: Programme implementation gaps have created circumstances where indigenous farmers (originally from the region) and migrating farmers (not originally from the region known as 'strangers' and 'farm hands'), women of reproductive age and school-aged children are continuously missed in MDA efforts in Cameroon. Key implementation challenges that limit access to MDA within this context include inadequate sensitization campaigns that don't sufficiently build trust with different groups; limits in CDD training around pregnancy and reproductive health; lack of alignment between distribution and community availability and the exclusion of existing formal and informal governance structures that have established trusting community relationships.Conclusion: Through identifying key populations missed in MDAs within specific contexts, we highlight how social inclusion and equity could be increased within the Cameroonian context. A main recommendation is to strengthen trust at the community level and work with established partnerships and local governance structures that can support sustainable solutions for more equitable MDA campaigns.
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Affiliation(s)
- Makia Christine Masong
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marlene Siping Tagne
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Marlene Ntchinda Tchoffo
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Sharon Ngang
- Department of Sciences, Research Center for Schistosomiasis and Parasitology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Rachael Thomson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louis-Albert Tchuem Tchuenté
- Department of Sciences, Research Center for Schistosomiasis and Parasitology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Estelle Kouokam
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
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Okoyo C, Campbell SJ, Williams K, Simiyu E, Owaga C, Mwandawiro C. Prevalence, intensity and associated risk factors of soil-transmitted helminth and schistosome infections in Kenya: Impact assessment after five rounds of mass drug administration in Kenya. PLoS Negl Trop Dis 2020; 14:e0008604. [PMID: 33027264 PMCID: PMC7540847 DOI: 10.1371/journal.pntd.0008604] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background In Kenya, over five million school age children (SAC) are estimated to be at risk of parasitic worms causing soil-transmitted helminthiasis (STH) and schistosomiasis. As such, the Government of Kenya launched a National School Based Deworming (NSBD) program in 2012 targeting the at-risk SAC living in endemic regions, with the aim of reducing infections prevalence to a level where they no longer constitute a public health problem. The impact of the program has been consistently monitored from 2012 to 2017 through a robust and extensive monitoring and evaluation (M&E) program. The aim of the current study was to evaluate the parasitological outcomes and additionally investigate water, sanitation and hygiene (WASH) related factors associated with infection prevalence after five rounds of mass drug administration (MDA), to inform the program’s next steps. Materials and methods We utilized a cross-sectional design in a representative, stratified, two-stage sample of school children across six regions in Kenya. A sample size of 100 schools with approximately 108 children per school was purposively selected based on the Year 5 STH infection endemicity prior to the survey. Stool samples were examined for the presence of STH and Schistosoma mansoni eggs using double-slide Kato-Katz technique, urine samples were processed using urine filtration technique for the presence of S. haematobium eggs. Survey questionnaires were administered to all the participating children to collect information on their demographic and individual, household and school level WASH characteristics. Principal findings Overall, STH prevalence was 12.9% (95%CI: 10.4–16.1) with species prevalence of 9.7% (95%CI: 7.5–12.6) for Ascaris lumbricoides, 3.6% (95%CI: 2.2–5.8) for Trichuris trichiura and 1.0% (95%CI: 0.6–1.5) for hookworm. S. mansoni prevalence was 2.2% (95%CI: 1.2–4.3) and S. haematobium prevalence was 0.3% (95%CI: 0.1–1.0). All the infections showed significant prevalence reductions when compared with the baseline prevalence, except S. mansoni. From multivariable analysis, increased odds of any STH infections were associated with not wearing shoes, adjusted odds ratio (aOR) = 1.36 (95%CI: 1.09–1.69); p = 0.007; high number of household members, aOR = 1.21 (95%CI: 1.04–1.41); p = 0.015; and school absenteeism of more than two days, aOR = 1.33 (95%CI: 1.01–1.80); p = 0.045. Further, children below five years had up to four times higher odds of getting STH infections, aOR = 4.68 (95%CI: 1.49–14.73); p = 0.008. However, no significant factors were identified for schistosomiasis, probably due to low prevalence levels affecting performance of statistical analysis. Conclusions After five rounds of MDA, the program shows low prevalence of STH and schistosomiasis, however, not to a level where the infections are not a public health problem. With considerable inter-county infection prevalence heterogeneity, the program should adopt future MDA frequencies based on the county’s infection prevalence status. Further, the program should encourage interventions aimed at improving coverage among preschool age children and improving WASH practices as long-term infection control strategies. This paper presents the findings of an evaluation survey conducted in Year 6 of the Kenya National School-Based Deworming (NSBD) Program, following five years (2012–2017) of prior baseline and subsequent impact monitoring. The survey was conducted in 20 counties, covering six regions in Kenya. The survey showed continued and considerable reductions in prevalence over time, with most marked decline for hookworm, followed by Ascaris lumbricoides. Overall, the mass drug administration (MDA) program has driven both STH and schistosomiasis prevalence to relatively low levels, however not to a point where they no longer constitute a public health problem in Kenya. For these neglected tropical diseases (NTDs), and STH in particular, there are relatively few published examples of programmatic impact assessments enabling refined decisions regarding helminth control strategies. Kenya’s experiences in implementing, monitoring, and evaluating a high-coverage NSBD program are a continuing and increasingly important success story for the country, which provides learnings of importance for the international community.
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Affiliation(s)
- Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- School of Mathematics, College of Biological and Physical Sciences, University of Nairobi, Nairobi, Kenya
- * E-mail: ,
| | - Suzy J. Campbell
- Deworm the World, Evidence Action, Washington DC, United States of America
| | | | - Elses Simiyu
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Charles Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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12
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Geyer RE, Ibikounlé M, Emmanuel-Fabula M, Roll A, Avokpaho E, Elijan A, Wèkè LC, Togbevi CI, Chabi F, Houngbégnon P, Luty AJF, Yard E, Walson JL, Graham S, Means AR. Gender norms and mass deworming program access in Comé, Benin: A qualitative assessment of gender-associated opportunities and challenges to achieving high mass drug administration coverage. PLoS Negl Trop Dis 2020; 14:e0008153. [PMID: 32302298 PMCID: PMC7164589 DOI: 10.1371/journal.pntd.0008153] [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: 07/17/2019] [Accepted: 02/19/2020] [Indexed: 12/03/2022] Open
Abstract
The World Health Organization’s Neglected Tropical Disease Roadmap has accelerated progress towards eliminating select neglected tropical diseases (NTDs). This momentum has catalyzed research to determine the feasibility of interrupting transmission of soil-transmitted helminths (STH) using community-wide mass drug administration (MDA). This study aims to identify potential gender-specific facilitators and barriers to accessing and participating in community-wide STH MDA, with the goal of ensuring programs are equitable and maximize the probability of interrupting STH transmission. This research was conducted prior to the launch of community-wide MDA for STH in Comé, Benin. A total of 10 focus group discussions (FGDs) were conducted separately among 40 men, 38 women, and 15 community drug distributors (CDDs). Salient themes included: both men and women believe that community-wide MDA would reduce the financial burden associated with self-treatment, particularly for low income adults. Community members believe MDA should be packaged alongside water, sanitation, and other health services. Women feel past community-wide programs have been disorganized and are concerned these distributions will be similar. Women also expressed interest in increased engagement in the implementation of future community-based public health programs. Men often did not perceive themselves to be at great risk for STH infection and did not express a high demand for treatment. Finally, the barriers discussed by CDDs generally did not align with gender-specific concerns, but rather represented concerns shared by both genders. A door-to-door distribution strategy for STH MDA is preferred by women in this study, as this platform empowers women to participate as health decision makers for their family. In addition, involving women in planning and implementation of community-wide programs may help to increase treatment coverage and compliance. Soil-transmitted helminths (STH) affect an estimated 1.5 billion people globally. The DeWorm3 Project is investigating if it is possible to interrupt transmission of STH with community-wide deworming of individuals of all ages. We conducted focus group discussions with adult men, women, and community drug distributors (CDDs) in Comé, Benin to identify gender-specific facilitators and barriers to accessing and participating in community-wide mass drug administration (MDA) programs. Our findings suggest that door-to-door community-wide MDA may not only improve MDA treatment coverage by increasing access but may also empower women by facilitating increased decision making on behalf of their regarding who is treated and where. Additionally, women may be an untapped resource for strategically reaching missed populations and women reported seeking increased involvement within the deworming of their families. Men did not perceive themselves to be at risk and thus did not have high demand for deworming. Both genders reported that they struggle to afford deworming drugs outside of MDA and that MDA coverage would be higher if treatment was integrated with water and sanitation services. Finally, CDDs generally identified only barriers and facilitators to MDA that were shared by both genders and may require more training to ensure MDA programs are equitable and effectively engage all at risk populations.
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Affiliation(s)
- Rachel E. Geyer
- Department of Global Health, University of Washington, Seattle, United States of America
- * E-mail:
| | - Moudachirou Ibikounlé
- Département de Zoologie, Faculté des Sciences et Techniques, Université d’Abomey-Calavi 01BP526, Cotonou, Benin
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | - Mira Emmanuel-Fabula
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Amy Roll
- Department of Global Health, University of Washington, Seattle, United States of America
| | | | - Abiguel Elijan
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | | | | | - Félicien Chabi
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | | | | | - Elodie Yard
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, United States of America
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Susan Graham
- Department of Global Health, University of Washington, Seattle, United States of America
- Department of Medicine, University of Washington, Seattle, United States of America
- Department of Epidemiology, University of Washington, Seattle, United States of America
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, United States of America
- Division of Life Sciences, Natural History Museum, London, United Kingdom
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13
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Masaku J, Njomo DW, Njoka A, Okoyo C, Mutungi FM, Njenga SM. Soil-transmitted helminths and schistosomiasis among pre-school age children in a rural setting of Busia County, Western Kenya: a cross-sectional study of prevalence, and associated exposures. BMC Public Health 2020; 20:356. [PMID: 32188444 PMCID: PMC7079432 DOI: 10.1186/s12889-020-08485-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Soil-transmitted helminths (STH) and schistosomiasis continue to cause serious health problems among affected communities. To ensure that infection transmission levels are reduced, repeated mass drug administration at regular intervals has been recommended by World Health Organization. Pre-school age children (PSAC) have been neglected both in terms of research activities and in control programmes in the past for reasons that they carry insignificant infection levels. The current study determined risk factors that contribute to differences in infection prevalence among enrolled and non-enrolled PSAC in Busia County, western Kenya. Methods This was a comparative cross-sectional study that compared STH and Schistosoma mansoni infections among enrolled and non-enrolled PSAC in Busia County. Simple random sampling was used to select study participants. A total of 327 enrolled and 326 non-enrolled PSAC (n = 653) were recruited from five participating schools, and the neighboring villages. Statistical analysis was performed using STATA version 14 (STATA Corporation, College Station, TX, USA). Differences in proportions were assessed using the z-test statistic for testing sample proportions. Univariable and multivariable logistic regression were used to test the associations between the variables. Results The prevalence of STH and Schistosoma mansoni infection was 17.0% (95%CI: 13.1–22.1), and 11.8% (95%CI:11.0–12.9) respectively. Specific STH species prevalence were 12.9% (95%CI:7.0–23.5) for Trichuris trichiura, 8.3% (95%CI:8.2–8.3) for Ascaris lumbricoides, and 1.2% (95%CI:1.2–1.2) for hookworms. Prevalence of T. trichiura was higher among enrolled PSAC 16.9% (95%CI: 6.8–41.9); p = 0.003, compared to the non-enrolled 8.9% (95%CI:4.3–18.2). From univariable analysis, lack of improved water source for drinking OR 2.01, (95%CI:1.29–3.13); p = 0.002, and not wearing shoes OR 3.42, (95%CI:1.14–10.29); p = 0.028, were some of the significant factors associated with STH infection. While for multivariable analysis, bathing/swimming in a river daily, aOR 3.99 (95%CI:1.98–8.06); p = 0.001 was a key significant factor for S. mansoni infections. Conclusion There was high prevalence of STH infection among enrolled PSAC despite having participated in the national school-based deworming programme. Hence the need for continued mass drug administration to reduce the intensity of infections among these age group. In addition, further research maybe needed to identify drivers of STH infection particularly T. trichiura among PSAC.
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Affiliation(s)
- Janet Masaku
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Mbangathi road, P.O.Box 54840-00200, Nairobi, Kenya.
| | - Doris W Njomo
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Mbangathi road, P.O.Box 54840-00200, Nairobi, Kenya
| | - Ann Njoka
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Mbangathi road, P.O.Box 54840-00200, Nairobi, Kenya
| | - Collins Okoyo
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Mbangathi road, P.O.Box 54840-00200, Nairobi, Kenya
| | - Faith M Mutungi
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Mbangathi road, P.O.Box 54840-00200, Nairobi, Kenya
| | - Sammy M Njenga
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Mbangathi road, P.O.Box 54840-00200, Nairobi, Kenya
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14
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McGuire F, Vijayasingham L, Vassall A, Small R, Webb D, Guthrie T, Remme M. Financing intersectoral action for health: a systematic review of co-financing models. Global Health 2019; 15:86. [PMID: 31849335 PMCID: PMC6918645 DOI: 10.1186/s12992-019-0513-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility. AIM This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. METHODS We conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded. RESULTS Of 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes. CONCLUSION Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals.
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Affiliation(s)
- Finn McGuire
- University of York (Centre for Health Economics), York, UK
| | - Lavanya Vijayasingham
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia.
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, (Centre for Health Economics in London (CHIL)), London, UK
| | - Roy Small
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
| | - Douglas Webb
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
| | - Teresa Guthrie
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
- Independent consultant, Cape Town, South Africa
| | - Michelle Remme
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
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Errea RA, Vasquez-Rios G, Calderon ML, Siu D, Duque KR, Juarez LH, Gallegos R, Uriol C, Rondon CR, Baca KP, Fabian RJ, Canales M, Terashima A, Marcos LA, Samalvides F. Soil-Transmitted Helminthiasis in Children from a Rural Community Taking Part in a Periodic Deworming Program in the Peruvian Amazon. Am J Trop Med Hyg 2019; 101:636-640. [PMID: 31309921 PMCID: PMC6726937 DOI: 10.4269/ajtmh.18-1011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Children in the Peruvian Amazon Basin are at risk of soil-transmitted helminths (STH) infections. This study aimed to determine the prevalence of STH infection in children from a rural Amazonian community of Peru and to elucidate epidemiological risk factors associated with its perpetuation while on a school-based deworming program with mebendazole. Stool samples of children aged 2-14 years and their mothers were analyzed through direct smear analysis, Kato-Katz, spontaneous sedimentation in tube, Baermann's method, and agar plate culture. A questionnaire was administered to collect epidemiological information of interest. Among 124 children, 25.8% had one or more STH. Individual prevalence rates were as follows: Ascaris lumbricoides, 16.1%; Strongyloides stercoralis, 10.5%; hookworm, 1.6%; and Trichuris trichiura, (1.6%). The prevalence of common STH (A. lumbricoides, T. trichiura, and hookworm) was higher among children aged 2-5 years than older children (31.6% versus 12.8%; P = 0.01). In terms of sanitation deficits, walking barefoot was significantly associated with STH infection (OR = 3.28; CI 95% = 1.11-12.07). Furthermore, STH-infected children more frequently had a mother who was concomitantly infected by STH than the non-STH-infected counterpart (36.4% versus 14.1%, P = 0.02). In conclusion, STH infection is highly prevalent in children from this Amazonian community despite routine deworming. Institutional health policies may include hygiene and sanitation improvements and screening/deworming of mothers to limit the dissemination of STH. Further studies are needed to address the social and epidemiological mechanics perpetuating these infections.
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Affiliation(s)
- Renato A. Errea
- Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - George Vasquez-Rios
- Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Maria L. Calderon
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Diego Siu
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kevin R. Duque
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luciana H. Juarez
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
- Scientific Society of Medical Students, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo Gallegos
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Celene Uriol
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
- Scientific Society of Medical Students, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claudia R. Rondon
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katia P. Baca
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosario J. Fabian
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marco Canales
- Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angelica Terashima
- Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis A. Marcos
- Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
- Infectious Diseases Division, SUNY/Stony Brook University, Stony Brook, New York
| | - Frine Samalvides
- Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Infectious, Tropical and Dermatological Diseases, Hospital Cayetano Heredia, Lima, Peru
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16
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Means AR, Ajjampur SSR, Bailey R, Galactionova K, Gwayi-Chore MC, Halliday K, Ibikounle M, Juvekar S, Kalua K, Kang G, Lele P, Luty AJF, Pullan R, Sarkar R, Schär F, Tediosi F, Weiner BJ, Yard E, Walson J. Evaluating the sustainability, scalability, and replicability of an STH transmission interruption intervention: The DeWorm3 implementation science protocol. PLoS Negl Trop Dis 2018; 12:e0005988. [PMID: 29346376 PMCID: PMC5773078 DOI: 10.1371/journal.pntd.0005988] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022] Open
Abstract
Hybrid trials that include both clinical and implementation science outcomes are increasingly relevant for public health researchers that aim to rapidly translate study findings into evidence-based practice. The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. DeWorm3 will use stakeholder mapping to identify individuals who influence or are influenced by school-based or community-wide mass drug administration (MDA) for STH and to evaluate network dynamics that may affect study outcomes and future policy development. Individual interviews and focus groups will generate the qualitative data needed to identify factors that shape, contextualize, and explain DeWorm3 trial outputs and outcomes. Structural readiness surveys will be used to evaluate the factors that drive health system readiness to implement novel interventions, such as community-wide MDA for STH, in order to target change management activities and identify opportunities for sustaining or scaling the intervention. Process mapping will be used to understand what aspects of the intervention are adaptable across heterogeneous implementation settings and to identify contextually-relevant modifiable bottlenecks that may be addressed to improve the intervention delivery process and to achieve intervention outputs. Lastly, intervention costs and incremental cost-effectiveness will be evaluated to compare the efficiency of community-wide MDA to standard-of-care targeted MDA both over the duration of the trial and over a longer elimination time horizon.
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Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, United States
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | | | - Robin Bailey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katya Galactionova
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Katherine Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Moudachirou Ibikounle
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Département de Zoologie, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Benin
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Pallavi Lele
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | | | - Rachel Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rajiv Sarkar
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Fabian Schär
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, United States
| | - Elodie Yard
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, United States
- Division of Life Sciences, Natural History Museum, London, United Kingdom
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