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Baker MC, Bardosh K, Fitch E, Mbabazi PS, Mwingira U, Direny A, Dean L, Sutherland EG, Krentel A. Incorporating qualitative research methods into the monitoring and evaluation of neglected tropical disease programmes: a scoping literature review. Int Health 2021; 13:504-513. [PMID: 34614183 PMCID: PMC8643435 DOI: 10.1093/inthealth/ihab059] [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: 07/09/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Abstract
This publication addresses the limited use of qualitative methods in neglected tropical disease (NTD) programmes. It describes a scoping literature review conducted to inform the development of a guide to inform the use of rapid qualitative assessments to strengthen NTD mass drug administration (MDA) programmes. The review assessed how qualitative methods are currently used by NTD programmes and identified qualitative approaches from other health and development programmes with the potential to strengthen the design of MDA interventions. Systematic review articles were reviewed and searched using key terms conducted on Google Scholar and PubMed. Results show that methods used by NTD programmes rely heavily on focus group discussions and in-depth interviews, often with time-consuming analysis and limited information on how results are applied. Results from other fields offered insight into a wider range of methods, including participatory approaches, and on how to increase programmatic uptake of findings. Recommendations on how to apply these findings to NTD control are made. The topic of human resources for qualitative investigations is explored and a guide to improve MDAs using qualitative methods is introduced. This guide has direct applicability across the spectrum of NTDs as well as other public health programmes.
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Affiliation(s)
- Margaret C Baker
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Kevin Bardosh
- Center for One Health Research, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Fitch
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Pamela S Mbabazi
- Department of Neglected Tropical Diseases, World Health Organization, 1221 Geneva 27, Switzerland
| | - Upendo Mwingira
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Abdel Direny
- CORUS International, Washington DC, WA 20036, USA
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Elizabeth G Sutherland
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, K1G5Z3, Canada
- Bruyere Research Institute, Ottawa, K1N 5C8, Canada
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Gibson L, Moffatt CJ, Narahari SR, Kabiri L, Ikhile D, Nchafack A, Dring E, Nursing D, Kousthubha SN, Gorry J. Global Knowledge Gaps in Equitable Delivery of Chronic Edema Care: A Political Economy Case Study Analysis. Lymphat Res Biol 2021; 19:447-459. [PMID: 34672793 DOI: 10.1089/lrb.2021.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Most existing research in chronic edema (CO) care takes place in high-income countries and is both clinically and medically focused, although often accorded low prestige and status. A myriad of challenges define the problems and important gaps in understanding and translating what we know into sustainable practice. Less considered, however, are the consequences and socioeconomic significance of this "knowledge gap" in an increasingly globalized world. This article seeks to address this lacuna by suggesting a political economy approach across three different income settings, the United Kingdom (high), Kerala in India (middle), and Uganda (low), to learn from international practice and understand the contribution of local (community-specific) health traditions. Methods and Result: We used a comparative case study approach. In the three case studies we demonstrate how particular thinking, sets of power relationships, and resource distributions influence and structure the provision of CO management more generally. We demonstrate how these intertwined and often invisible processes reflect a market-led biomedical hierarchization that focuses on high-interventionist, high-cost approaches that are then imposed on lower income settings. At the same time, low-cost but evidence-based local knowledge innovation in wound and CO care from low- or middle-income countries is neither recognized nor valued. Conclusion: We conclude that unpacking these dynamics is a necessary route to providing a more equitable health delivery accessible for the many rather than the few.
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Affiliation(s)
- Linda Gibson
- Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, United Kingdom
| | - Christine J Moffatt
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom.,Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Institute of Nursing and Midwifery Care Excellence, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - S R Narahari
- Institute of Applied Dermatology, Kasaragod, India
| | - Lydia Kabiri
- School of Health Sciences, Makerere University, Kampala, Uganda, Africa
| | - Deborah Ikhile
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Almighty Nchafack
- Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Dip Nursing
- Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals, Nottingham, United Kingdom
| | - S N Kousthubha
- Shri Dharmasthala Manjunatheshwara College of Medical Sciences, Dharwad, India
| | - Jonathan Gorry
- School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
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Abstract
Scabies is an infestation of the skin caused by the mite Sarcoptes scabiei. In 2017, scabies was recognised by the World Health Organisation as a disease of public importance and was consequently added to the list of neglected tropical diseases. An estimated 200 million people currently have scabies worldwide. Scabies is endemic in many developing countries, with the highest prevalence being in hot, humid climates such as the Pacific and Latin American regions. Scabies causes a host immune response which is intensely itchy. Scratching of the lesions can lead to secondary bacterial infections of the skin, such as impetigo, most commonly caused by Streptococcus pyogenes or Staphylococcus aureus. This can have fatal consequences, such as septicaemia, glomerulonephritis, and rheumatic heart disease. Advances over the past 5 years indicate that mass drug administration is an effective strategy to treat scabies. This review will outline advances in the mite biology, epidemiological understanding, diagnosis, and treatment of scabies.
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Affiliation(s)
- Emily Welch
- St Vincent’s Hospital, University of New South Wales, Sydney, Australia
| | | | - Margot J Whitfeld
- St Vincent’s Hospital, University of New South Wales, Sydney, Australia
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Amazigo UV, Leak SGA, Zoure HGM, Okoronkwo C, Diop Ly M, Isiyaku S, Crump A, Okeibunor JC, Boatin B. Community-directed distributors-The "foot soldiers" in the fight to control and eliminate neglected tropical diseases. PLoS Negl Trop Dis 2021; 15:e0009088. [PMID: 33661903 PMCID: PMC7932156 DOI: 10.1371/journal.pntd.0009088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The neglected tropical diseases (NTDs) affect hundreds of millions of people, predominantly in rural, often difficult-to-access areas, poorly served by national health services. Here, we review the contributions of 4.8 million community-directed distributors (CDDs) of medicines over 2 decades in 146,000 communities in 27 sub-Saharan African countries to control or eliminate onchocerciasis and lymphatic filariasis (LF). We examine their role in the control of other NTDs, malaria, HIV/AIDS interventions, immunisation campaigns, and support to overstretched health service personnel. We are of the opinion that CDDs as community selected, trained, and experienced “foot soldiers,” some of whom were involved in the Ebola outbreak responses at the community level in Liberia, if retrained, can assist community leaders and support health workers (HWs) in the ongoing Coronavirus Disease 2019 (COVID-19) crisis. The review highlights the improved treatment coverage where there are women CDDs, the benefits and lessons from the work of CDDs, their long-term engagement, and the challenges they face in healthcare delivery. It underscores the value of utilising the CDD model for strong community engagement and recommends the model, with some review, to hasten the achievement of the NTD 2030 goal and assist the health system cope with evolving epidemics and other challenges. We propose that, based on the unprecedented progress made in the control of NTDs directly linked to community engagement and contributions of CDDs “foot soldiers,” they deserve regional and global recognition. We also suggest that the World Health Organization (WHO) and other international stakeholders promote policy and guidance for countries to adapt this model for the elimination of NTDs and to strengthen national health services. This will enhance the accomplishment of some Sustainable Development Goals (SDGs) by 2030 in sub-Saharan Africa. Community-directed distributors (CDDs), sometimes known as community health workers (CHWs), have proved to be critical in the delivery of medicines and other tools for the control of neglected tropical diseases (NTDs), prevention of malaria, and other beneficial health interventions. The distributors are the unsung heroes and heroines without whom the health of hundreds of thousands of communities in rural Africa would be worse than it is today. In this paper, we document more than 2 decades (1997–2019) of the contributions of 146,000 communities and 4.8 million CDDs of medicines for NTDs, unpaid or minimally compensated, some have provided 18 years of uninterrupted service. We report on the burden of work and their perspectives of the challenges involved in mass drug administration (MDA) across 27 countries in sub-Saharan Africa. We suggest that they have not been adequately recognised and that harnessing such community human resources could contribute to improving health system’s responses to the ongoing Coronavirus Disease 2019 (COVID-19) crisis. We recommend policy measures for a wider application of existing networks of CDDs by countries’ health systems to consolidate and accelerate the achievements made as well as for the attainment of the goals set forth in the newly developed World Health Organization (WHO) NTD Roadmap.
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Affiliation(s)
- Uche V. Amazigo
- African Programme for Onchocerciasis Control, World Health Organization, Enugu, Nigeria
- * E-mail:
| | - Stephen G. A. Leak
- African Programme for Onchocerciasis Control, World Health Organization, Macclesfield, Cheshire, United Kingdom
| | | | | | | | | | | | | | - Boakye Boatin
- Onchocerciasis Control Programme in West Africa, World Health Organization, Accra, Ghana
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Krentel A, Gyapong M, McFarland DA, Ogundahunsi O, Titaley CR, Addiss DG. Keeping communities at the centre of efforts to eliminate lymphatic filariasis: learning from the past to reach a future free of lymphatic filariasis. Int Health 2021; 13:S55-S59. [PMID: 33349882 PMCID: PMC7753171 DOI: 10.1093/inthealth/ihaa086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Since the launch of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000, more than 910 million people have received preventive chemotherapy for lymphatic filariasis (LF) and many thousands have received care for chronic manifestations of the disease. To achieve this, millions of community drug distributors (CDDs), community members and health personnel have worked together each year to ensure that at-risk communities receive preventive chemotherapy through mass drug administration (MDA). The successes of 20 y of partnership with communities is celebrated, including the application of community-directed treatment, the use of CDDs and integration with other platforms to improve community access to healthcare. Important challenges facing the GPELF moving forward towards 2030 relate to global demographic, financing and programmatic changes. New innovations in research and practice present opportunities to encourage further community partnership to achieve the elimination of LF as a public health problem. We stress the critical need for community ownership in the current Covid-19 pandemic, to counter concerns in relaunching MDA programmes for LF.
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Affiliation(s)
- Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Canada K1G 5Z3.,Bruyère Research Institute, Ottawa K1R 6M1, Canada
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences Ho, Volta Region, Ghana
| | | | | | - Christiana R Titaley
- Faculty of Medicine, Pattimura University, Maluku Province, Ambon 97233 Indonesia
| | - David G Addiss
- Focus Area for Compassion and Ethics (FACE), The Task Force for Global Health, Atlanta 30030 USA
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Njomo DW, Kimani BW, Kibe LW, Okoyo C, Omondi WP, Sultani HM. Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya. PLoS Negl Trop Dis 2020; 14:e0009012. [PMID: 33370300 PMCID: PMC7793263 DOI: 10.1371/journal.pntd.0009012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 01/08/2021] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
Community drug distributors (CDDs) who are volunteers have the responsibility of awareness creation, household census, drug distribution and record-keeping and are thus key stakeholders in the campaign for Lymphatic Filariasis (LF) elimination. Taking into account their experiences and perceptions is important for a successful elimination campaign. We conducted a qualitative study in 2018 to identify implementation challenges and opportunities for improved mass drug administration (MDA) uptake based on the CDDs perceptions and experiences. Within a larger study that used mixed methods quasi-experimental design, we collected qualitative data from two wards in Kaloleni Sub-County of Kilifi County which was purposively selected owing to its low, 56% and 50.5% treatment coverage in 2015 and 2016 respectively. Focus group discussions (FGDs) (n = 8) and in-depth interviews (IDIs) (n = 8) with CDDs, IDIs (n = 22) with opinion leaders and IDIs (n = 8) with health workers were conducted and the data analyzed by QSR NVIVO version 10 according to thematic areas. The results showed that based on the perceptions and experiences of the CDDs, several challenges: communities’ refusal to take the drugs; absenteeism during MDA; non-adherence to CDDs selection criteria; inadequacy in number of CDDs engaged during the campaign and training provided; insufficiency of drugs issued to CDDs; lack of CDDs supervision and low motivation negatively impact on MDA uptake. Opportunities to address the challenges included: awareness creation on MDA, health education on LF and observation of hygiene during drug administration, increased duration of awareness creation and drug administration, adherence to CDDs selection criteria and putting into consideration the vastness of an area and population density while deploying CDDs. Other opportunities include: improved CDDs training and scheduling; issuing of enough drugs to CDDs to meet the communities’ demand and improved supervision and motivation of CDDs. Addressing the challenges highlighted is an important step of maximizing MDA uptake. The opportunities presented need to be considered by the NTD program personnel, the county health personnel and the community while planning the implementation of MDA campaigns. Elephantiasis infection which is common in tropical areas is targeted for elimination globally through delivery of drugs to all populations living in areas where infections occur. Community Drug Distributors (CDDs) are persons who live in the affected communities and who volunteer themselves to distribute drugs after receiving training from the health care workers. Understanding the challenges and opportunities for improved community drug uptake from the perspectives and experiences of the CDDs is important for a successful elimination campaign. As part of a larger study to address barriers of drug uptake in Kenya, we collected qualitative data to explore the challenges and opportunities for improved drug uptake in two wards of Kilifi County. The data was collected through focus group discussions and in-depth interviews and analyzed. For drug uptake to be improved, the CDDs’ mentioned challenges related to how their selection is done, number of CDDs engaged, quality of their training, quantities of drugs issued to them, supervision and motivation that need to be addressed. The communities targeted for treatment need well scheduled health education activities on elephantiasis, awareness creation on drug distribution and drug reaction for them to understand the importance of receiving the treatment. These findings suggest the need for strong collaborations between NTD program, county health personnel and the community that are useful in the planning the implementation of successful national programs.
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Affiliation(s)
- Doris W. Njomo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- * E-mail: ,
| | - Bridget W. Kimani
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lydiah W. Kibe
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Wyckliff P. Omondi
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Hadley M. Sultani
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
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Akurut H, Sanya RE, Lubyayi L, Nampijja M, Kizza M, Kaweesa J, Kizindo R, Sewankambo M, Nsubuga D, Tukahebwa E, Kabatereine NB, Elliott AM, Webb EL. Anthelminthic treatment receipt and its predictors in Lake Victoria fishing communities, Uganda: Intervention coverage results from the LaVIISWA cluster randomised trial. PLoS Negl Trop Dis 2020; 14:e0008718. [PMID: 33075067 PMCID: PMC7595614 DOI: 10.1371/journal.pntd.0008718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/29/2020] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mass drug administration (MDA) is a cornerstone of control of parasitic helminths. In schistosomiasis-endemic areas with >50% of school-aged children infected, community-wide MDA with praziquantel is recommended by the World Health Organisation (WHO), with target coverage of >75%. Using data from a cluster-randomised trial of MDA treatment strategies, we aimed to describe the proportion of eligible residents who received MDA and predictors of treatment receipt, and to assess associations with helminth prevalence. METHODS In the Koome islands of Lake Victoria, Uganda, where baseline schistosomiasis prevalence (by single stool sample, Kato Katz) was 52% overall (all ages) and 67% among school-aged children, we conducted a cluster-randomised trial of community-wide, intensive MDA (quarterly single-dose praziquantel 40mg/kg; triple-dose albendazole 400mg) versus standard, Uganda government intervention (annual single-dose praziquantel 40mg/kg; 6-monthly single-dose albendazole). Twenty-six fishing villages were randomised, 13 per trial arm, for four years. At each treatment round, praziquantel treatment and the first dose of albendazole treatment were directly observed by the study team, registers of village residents were updated and the proportion receiving treatment among those eligible recorded. RESULTS During the four-year MDA, at each treatment round an average of 13,382 people were registered in the 26 villages (7,153 and 6,229 in standard and intensive intervention villages, respectively). Overall, the proportion of those eligible receiving praziquantel was lower than for albendazole (60% versus 65%), particularly in the standard arm (61% versus 71%) compared to the intensive arm (60% versus 62%). Albendazole receipt was lower when given concurrently with praziquantel. Absence was the commonest reason for non-receipt of treatment (81% albendazole, 77% praziquantel), followed by refusal (14% albendazole, 18% praziquantel). Proportions receiving treatment were lowest among school-aged children, but did not differ by sex. Longitudinal analysis of a subgroup of residents who did not move during the study period found that persistent non-receipt of treatment in this subgroup was rare. Refusal to receive treatment was highest among adults and more common among females. CONCLUSION In schistosomiasis high-risk communities, a combination of approaches to increasing treatment coverage, such as extended periods of treatment delivery, and the provision of incentives, may be required to achieve WHO targets.
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Affiliation(s)
- Hellen Akurut
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
| | - Richard E. Sanya
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lawrence Lubyayi
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
| | - Margaret Nampijja
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
| | - Moses Kizza
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
| | - James Kaweesa
- Vector Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Robert Kizindo
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
| | - Moses Sewankambo
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
| | - Denis Nsubuga
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
| | | | | | - Alison M. Elliott
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Emily L. Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom
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Binder S, Campbell CH, Castleman JD, Kittur N, Kinung'hi SM, Olsen A, Magnussen P, Karanja DMS, Mwinzi PNM, Montgomery SP, Secor WE, Phillips AE, Dhanani N, Gazzinelli-Guimaraes PH, Clements MN, N'Goran EK, Meite A, Utzinger J, Hamidou AA, Garba A, Fleming FM, Whalen CC, King CH, Colley DG. Lessons Learned in Conducting Mass Drug Administration for Schistosomiasis Control and Measuring Coverage in an Operational Research Setting. Am J Trop Med Hyg 2020; 103:105-113. [PMID: 32400352 PMCID: PMC7351302 DOI: 10.4269/ajtmh.19-0789] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was created to conduct research that could inform programmatic decision-making related to schistosomiasis. SCORE included several large cluster randomized field studies involving mass drug administration (MDA) with praziquantel. The largest of these were studies of gaining or sustaining control of schistosomiasis, which were conducted in five African countries. To enhance relevance for routine practice, the MDA in these studies was coordinated by or closely aligned with national neglected tropical disease (NTD) control programs. The study protocol set minimum targets of at least 90% for coverage among children enrolled in schools and 75% for all school-age children. Over the 4 years of intervention, an estimated 3.5 million treatments were administered to study communities. By year 4, the median village coverage was at or above targets in all studies except that in Mozambique. However, there was often a wide variation behind these summary statistics, and all studies had several villages with very low or high coverage. In studies where coverage was estimated by comparing the number of people treated with the number eligible for treatment, denominator estimation was often problematic. The SCORE experiences in conducting these studies provide lessons for future efforts that attempt to implement strong research designs in real-world contexts. They also have potential applicability to country MDA campaigns against schistosomiasis and other NTDs, most of which are conducted with less logistical and financial support than was available for the SCORE study efforts.
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Affiliation(s)
- Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Jennifer D Castleman
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Safari M Kinung'hi
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Diana M S Karanja
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N M Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna E Phillips
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Neerav Dhanani
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | | | - Michelle N Clements
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Eliézer K N'Goran
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Aboulaye Meite
- Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Amina A Hamidou
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, Preventive Chemotherapy and Transmission Control Unit, World Health Organization, Geneva, Switzerland
| | - Fiona M Fleming
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, Global Health Institute, University of Georgia, Athens, Georgia
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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Kusi C, Steinmann P, Merten S. The fight against lymphatic filariasis: perceptions of community drug distributors during mass drug administration in coastal Kenya. Infect Dis Poverty 2020; 9:22. [PMID: 32114985 PMCID: PMC7050125 DOI: 10.1186/s40249-020-0638-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Lymphatic filariasis (LF), a neglected tropical disease (NTD) and leading cause of global disability, is endemic in 32 countries in Africa with almost 350 million people requiring regular drug administration, and only 16 countries achieving target coverage. Community Drug Distributors (CDDs) are critical for the success of NTD programs, and the distribution of medicines during mass drug administration (MDA) in Africa; however they could also be a weak link. The primary aim of this study is to explore and describe perceptions of CDDs during MDA for LF in Mvita sub-county in Mombasa county and Kaloleni sub-county in Kilifi county, Kenya; and provide recommendations for the effective engagement of communities and CDDs in low-resource settings. Methods In September 2018, we conducted six focus group discussions with community members in each sub-county, three with men aged 18–30, 31–50, and 51 years and above and three with women stratified into the same age groups. In each sub-county, we also conducted semi-structured interviews with nine community health extension workers (CHEWs), the national LF focal point, the county NTD focal points, and seven community leaders. Content analysis of the data was conducted, involving a process of reading, coding, and displaying data in order to develop a codebook. Results We found that several barriers and facilitators impact the engagement between CDDs and community members during MDA. These barriers include poor communication and trust between CDDs and communities; community distrust of the federal government; low community knowledge and perceived risk of LF, poor timing of MDA, fragmented supervision of CDDs during MDA; and CDD bias when distributing medicines. We also found that CDD motivation was a critical factor in their ability to successfully meet MDA targets. It was acknowledged that directly observed treatment and adequate health education were often not executed by CDDs. The involvement of community leaders as informal supervisors of CDDs and community members improves MDA. Conclusions In order to achieve global targets around the elimination of LF, CDDs and communities must be effectively engaged by improving planning and implementation of MDA.
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Affiliation(s)
- Caroline Kusi
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Shoemaker EA, Dale K, Cohn DA, Kelly MP, Zoerhoff KL, Batcho WE, Bougouma C, Nko’Ayissi GB, Meite A, Marfo B, Goepogui A, Telfort MA, Sianipar LR, Traore M, Rimal P, Alfari DA, Anyaike C, Badiane FN, Kargbo-Labour I, Mwingira UJ, Awoussi MS, Stelmach RD, Smith CL, Arney J, Faramand TH, Stukel DM, Pou B, Rotondo LA, Kraemer JD, Baker MC. Gender and neglected tropical disease front-line workers: Data from 16 countries. PLoS One 2019; 14:e0224925. [PMID: 31856174 PMCID: PMC6922366 DOI: 10.1371/journal.pone.0224925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background Delivery of preventive chemotherapy (PC) through mass drug administration (MDA) is used to control or eliminate five of the most common neglected tropical diseases (NTDs). The success of an MDA campaign relies on the ability of drug distributors and their supervisors—the NTD front-line workers—to reach populations at risk of NTDs. In the past, our understanding of the demographics of these workers has been limited, but with increased access to sex-disaggregated data, we begin to explore the implications of gender and sex for the success of NTD front-line workers. Methodology/Principal findings We reviewed data collected by USAID-supported NTD projects from national NTD programs from fiscal years (FY) 2012–2017 to assess availability of sex-disaggregated data on the workforce. What we found was sex-disaggregated data on 2,984,908 trainees trained with financial support from the project. We then analyzed the percentage of males and females trained by job category, country, and fiscal year. During FY12, 59% of these data were disaggregated by sex, which increased to nearly 100% by FY15 and was sustained through FY17. In FY17, 43% of trainees were female, with just four countries reporting more females than males trained as drug distributors and three countries reporting more females than males trained as trainers/supervisors. Except for two countries, there were no clear trends over time in changes to the percent of females trained. Conclusions/Significance There has been a rapid increase in availability of sex-disaggregated data, but little increase in recruitment of female workers in countries included in this study. Women continue to be under-represented in the NTD workforce, and while there are often valid reasons for this distribution, we need to test this norm and better understand gender dynamics within NTD programs to increase equity.
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Affiliation(s)
| | - Kelly Dale
- WI-HER, Vienna, Virginia, United States of America
| | | | | | | | - Wilfrid E. Batcho
- National Communicable Disease Control Program, Ministry of Health, Cotonou, Republic of Benin
| | - Clarisse Bougouma
- National Neglected Tropical Disease Control Program, Disease Control Directorate, Ministry of Health, Ouagadougou, Burkina Faso
| | - Georges B. Nko’Ayissi
- Malaria and Neglected Tropical Diseases Sub-Department, Ministry of Public Health, Yaoundé, Republic of Cameroon
| | - Aboulaye Meite
- National Control Program for Preventive Chemotherapy Neglected Tropical Diseases, Ministry of Health and Public Hygiene, Abidjan, Republic of Côte d'Ivoire
| | - Benjamin Marfo
- National Neglected Tropical Diseases Program, Ghana Health Service, Accra, Republic of Ghana
| | - André Goepogui
- National Onchocerciasis and Blindness and Neglected Tropical Disease Control Program, National Prevention and Community Health Directorate, Ministry of Health, Conakry, Republic of Guinea
| | - Marc-Aurele Telfort
- National Malaria Control Program, Ministry of Public Health and Population, Port-au-Prince, Republic of Haiti
| | - Lita Renata Sianipar
- Sub-Directorate of Filariasis & Helminthiasis Control, Directorate of Vector Borne Disease Control, Directorate General of Communicable Disease and Environmental Health, Ministry of Health, Jakarta, Republic of Indonesia
| | - Mahamadou Traore
- National Schistosomiasis and Soil-Transmitted Helminths Control Program, Ministry of Health and Public Hygiene, Bamako, Mali
| | - Pradip Rimal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health, Kathmandu, Federal Democratic Republic of Nepal
| | - Djibo Aichatou Alfari
- NTD Control Program, Directorate of the Protection of Public Health, Ministry of Public Health, Niamey, Republic of Niger
| | - Chukwuma Anyaike
- Department of Public Health, Neglected Tropical Diseases Division, Federal Ministry of Health, Abuja, Federal Republic of Nigeria
| | - Fatou N. Badiane
- NTD Control Program, Disease Control Directorate, Ministry of Health and Social Work, Dakar, Senegal
| | - Ibrahim Kargbo-Labour
- Neglected Tropical Diseases Programme, Disease Prevention and Control Directorate, Ministry of Health and Sanitation, Freetown, Republic of Sierra Leone
| | - Upendo J. Mwingira
- Neglected Tropical Diseases Control Programme, Ministry of Health, Dar es Salaam, United Republic of Tanzania
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Marcel S. Awoussi
- National Neglected Tropical Disease Control Program, General Directorate of Health, Ministry of Health and Social Welfare, Lomé, Republic of Togo
| | | | - Carly L. Smith
- Office of Infectious Diseases, US Agency for International Development, Washington, DC, United States of America
| | | | | | | | - Bolivar Pou
- FHI 360, Washington, DC, United States of America
| | | | - John D. Kraemer
- RTI International, Washington, DC, United States of America
- Department of Health Systems Administration, Georgetown University, Washington, DC, United States of America
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Macfarlane CL, Dean L, Thomson R, Garner P. Community drug distributors for mass drug administration in neglected tropical disease programmes: systematic review and analysis of policy documents. J Glob Health 2019; 9:020414. [PMID: 31662849 PMCID: PMC6790237 DOI: 10.7189/jogh.09.020414] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Mass drug administration (MDA) programmes for neglected tropical diseases (NTDs) depend on voluntary community drug distributors (CDDs) to deliver drugs, and these volunteer schemes need regular training and supervision. NTD policy now includes integration of multiple disease programmes, but we are unsure if there is clarity in what is currently expected of CDDs and how they are managed. We therefore analysed World Health Organization (WHO) policy, strategy and implementation guidance, and select national NTD programme implementation plans. Methods Included are a) WHO global and WHO-Regional Office for Africa guidelines, strategies, operational manuals and meeting reports published between January 2007 to February 2018 that included policy and plans for CDDs; and b) national NTD programme master plans for Cameroon, Ghana, Liberia and Nigeria. For both review components, we examined the CDD responsibilities through a framework developed iteratively against the documents and prepared a narrative synthesis. Results Twenty WHO policy documents met the inclusion criteria. In the twelve global and eight regional documents, the CDD role was not explicitly or comprehensively defined. Three documents mentioned CDDs will distribute drugs; some mentioned health promotion, data handling and engagement in clinical care. Four WHO documents noted a need for CDD training or management, eight detailed some aspect of this, and one regional document provided a comprehensive overview. In the national plans, additional responsibilities included case management in two countries and transmission control in two countries. Every plan included training and supervision, but this was not always explicit, and details of the purpose and frequency varied. In all national plans, CDD motivation was identified as a challenge but not comprehensively addressed, although one document mentioned provision of bicycles. Conclusions WHO and national policies and plans assume CDDs will implement NTD programmes. However, there is almost no clear delineation of responsibilities, nor is there up-to-date practical guidance to guide managers. This ambiguity, in relation to the lack of explicit policies or programmatic guidance, probably impairs the effectiveness of NTD programmes.
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Affiliation(s)
- Cara L Macfarlane
- Centre for Evidence Synthesis in Global Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rachael Thomson
- Department for Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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The division of labour between community medicine distributors influences the reach of mass drug administration: A cross-sectional study in rural Uganda. PLoS Negl Trop Dis 2019; 13:e0007685. [PMID: 31483784 PMCID: PMC6726135 DOI: 10.1371/journal.pntd.0007685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/04/2019] [Indexed: 11/19/2022] Open
Abstract
Background Despite decades of community-based mass drug administration (MDA) for neglected tropical diseases, it remains an open question as to what constitutes the best combination of community medicine distributors (CMDs) for achieving high (>65%/75%) treatment rates within a village. Methods Routine community-based MDA was evaluated in Mayuge District, Uganda. For one month, we tracked 6,148 individuals aged 1+ years in 1,118 households from 28 villages. Praziquantel, albendazole, and ivermectin were distributed to treat Schistosoma mansoni, lymphatic filariasis, and soil-transmitted helminths. The similarity/diversity between CMDs was observed and used to predict the division of labour and overall village treatment rates. The division of labour was calculated by dividing the lowest treatment rate by the highest treatment rate achieved by two CMDs within a village. CMD similarity was measured for 16 characteristics including friendship network overlap, demographic and socioeconomic factors, methods of CMD selection, and years as CMD. Relevant variables for MDA outcomes were selected through least absolute shrinkage and selection operators with leave-one-out cross validation. Final models were run with ordinary least squares regression and robust standard errors. Results The percentage of individuals treated with at least one drug varied across villages from 2.79–89.74%. The only significant predictor (p-value<0.05) of village treatment rates was the division of labour. The estimated difference between a perfectly equal (a 50–50 split of individuals treated) and unequal (one CMD treating no one) division of labour was 39.69%. A direct tie (close friendship) between CMDs was associated with a nearly twofold more equitable distribution of labour when compared to CMDs without a direct tie. Conclusions An equitable distribution of labour between CMDs may be essential for achieving treatment targets of 65%/75% within community-based MDA. To improve the effectiveness of CMDs, national programmes should explore interventions that seek to facilitate communication, friendship, and equal partnership between CMDs. Community-based mass drug administration (MDA) uses volunteers within at-risk communities to distribute preventive chemotherapies en masse for neglected tropical diseases. Treatment rates achieved by community medicine distributors (CMDs) vary widely and can undermine morbidity control. We studied routine community-based MDA in 28 villages near Lake Victoria in Uganda. There were two CMDs per village who were tasked with moving from home-to-home to administer praziquantel, albendazole, and ivermectin for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths. We observed treatment outcomes for 6,148 eligible individuals aged 1+ years. Here we identified the best combination of CMD characteristics for achieving high village-level treatment rates. We found that a more equal division of labour (e.g. 50–50 split between how many people each CMD treated) was associated with higher treatment rates when compared to CMDs with an unequal division of labour (e.g. one CMD treating no one). CMDs who were friends were more likely to have a division of labour that was nearly twofold more equal than CMDs who were not friends. The similarity of CMDs with respect to network, demographic, or socioeconomic characteristics did not influence village treatment rates. National programmes should explore interventions that seek to facilitate communication, friendship, and equal partnership between CMDs.
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