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Sangare M, Diabate AF, Coulibaly YI, Tanapo D, Thera SO, Dolo H, Dicko I, Coulibaly O, Sall B, Traore F, Doumbia S, Kulkarni MA, Nutman TB, Krentel A. Understanding the barriers and facilitators related to never treatment during mass drug administration among mobile and migrant populations in Mali: a qualitative exploratory study. BMJ Glob Health 2024; 9:e015671. [PMID: 39384331 DOI: 10.1136/bmjgh-2024-015671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 09/23/2024] [Indexed: 10/11/2024] Open
Abstract
INTRODUCTION Five of the neglected tropical diseases use a strategy of preventative chemotherapy distributed via mass drug administration (MDA) for all eligible people living in endemic areas. To be successful, high coverage must be sustained over multiple rounds. Therefore, it will be difficult to reach elimination as a public health problem using MDA if there remain clusters of people who have never been treated. The study aims to explore the reasons why people with high mobility report being never treated during MDA and to provide evidence to support the development of standardised questions for data collection using qualitative research tools. METHODS We conducted an exploratory study using qualitative methods among displaced people, nomads/transhumants and economic migrants who self-reported that they had never been treated during MDA in the health districts of Tominian and Kalabancoro in Mali. Data were collected through in-depth individual interviews and focus group discussions. Nvivo V.14 software was used for data management and analysis. RESULTS The main reasons reported for never treatment included: geographical mobility, lack of awareness/information, negative rumours, fear of side effects, conflict and insecurity and logistical difficulties faced in reaching these populations. Proposed solutions included involving communities in the MDA, increasing awareness and information campaigns, effectively managing side effects, and designing and implementing flexible and effective interventions. CONCLUSION This study highlights that there are people with high mobility who may never have been treated during any round of MDA. The reasons for never treatment highlight the challenges faced when reaching particular groups during MDA activities/interventions. Suggested remedies will require programmes to implement more flexible and tailored interventions. Customised approaches based on the context are essential to guarantee fair access to preventive chemotherapy. Effective interventions must consider the supply and demand side in crafting interventions. This research adds to the evidence base to understand never treatment, particularly among highly mobile population groups and in schistosomiasis elimination programmes.
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Affiliation(s)
- Moussa Sangare
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Abdoul Fatao Diabate
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Yaya Ibrahim Coulibaly
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
- Dermatology Hospital of Bamako, Bamako, Mali
| | - Diadje Tanapo
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Sekou Oumarou Thera
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Housseini Dolo
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Ilo Dicko
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Oumar Coulibaly
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Binta Sall
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Fatoumata Traore
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Seydou Doumbia
- International Center of Excellence in Research in Mali, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Manisha A Kulkarni
- School of Epidemiology and Public Heath, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Alison Krentel
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Heath, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
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Fu H, Zhu C. The impact of population influx on infectious diseases - from the mediating effect of polluted air transmission. Front Public Health 2024; 12:1344306. [PMID: 39139663 PMCID: PMC11319163 DOI: 10.3389/fpubh.2024.1344306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 07/10/2024] [Indexed: 08/15/2024] Open
Abstract
The global population influx during the COVID-19 pandemic poses significant challenges to public health, making the prevention and control of infectious diseases a pressing concern. This paper aims to examine the impact of population influx on the spread of infectious diseases, with a specific emphasis on the mediating role of air pollution in this process. A theoretical analysis is conducted to explore the relationship between population influx, air pollution, and infectious diseases. Additionally, we establish a series of econometric models and employ various empirical tests and analytical techniques, including mediation effect test, threshold effect test, and systematic GMM test, to evaluate our hypotheses. The results indicate that: (1) Population influx directly and indirectly impacts infectious diseases. Specifically, population influx not only directly elevates the risk of infectious diseases, but also indirectly increases the incidence rate of infectious diseases by intensifying air pollution. (2) The impact of population inflow on infectious diseases exhibits regional heterogeneity. Compared to central and western China, the eastern regions exhibit a significantly higher risk of infectious diseases, exceeding the national average. (3) External factors influence the relationship between population influx and infectious diseases differently. Personal income and medical resources both help mitigate the risk of infectious diseases due to population influx, with medical resources having a more substantial effect. Contrary to expectations, abundant educational resources have not reduced the risk, instead, they have exacerbated the risk associated with population influx. This paper provides a scientific basis for formulating effective strategies for the prevention and control of infectious diseases.
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Affiliation(s)
- Haifeng Fu
- School of Transportation Management, Jiangxi Vocational and Technical College of Communications, Nanchang, Jiangxi, China
| | - Chaoping Zhu
- School of Software, Jiangxi Normal University, Nanchang, Jiangxi, China
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Badia-Rius X, Sitoe HM, Lopes S, Kelly-Hope LA. Impact of conflict on the elimination targets of lymphatic filariasis, schistosomiasis and soil-transmitted helminths in Cabo Delgado province, Mozambique. PLoS Negl Trop Dis 2024; 18:e0012119. [PMID: 38635840 PMCID: PMC11060522 DOI: 10.1371/journal.pntd.0012119] [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: 10/25/2023] [Revised: 04/30/2024] [Accepted: 03/29/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Mozambique has one of the highest burdens of neglected tropical diseases in Africa. Lymphatic filariasis, schistosomiasis and soil-transmitted helminths are being targeted for elimination as part of integrated mass drug administration campaigns. The progress made towards interruption of transmission has been affected by recent conflict in Cabo Delgado province. The aim of this paper was to determine the potential impact of this crisis on the neglected tropical diseases programme and the challenges in reaching the elimination goals of 2030. METHODOLOGY A desk-based secondary data analysis was conducted on publicly available sources of neglected tropical diseases, conflict incidents, internally displaced persons and geographical access between 2020 and 2022. Data were summarised and mapped using GIS software. A combined risk stratified assessment at district level was developed with five classifications i) Very high-risk; ii) High-risk; iii) Medium to high-risk; iv) Medium risk; and v) Not at risk due to conflict absence but co-endemic. RESULTS Lymphatic filariasis, schistosomiasis and soil-transmitted helminths were co-endemic in 115 out of 156 (74%) districts. Between 2020 and 2022 a total of 1,653 conflict-related incidents were reported, most of them in Cabo Delgado province (n = 1,397, 85%). A five-fold increase of internally displaced persons was recorded from April 2020 (n = 172,186) to November 2022 (n = 935,130). Geographical accessibility also deteriorated across the province with an increase from five (29%) in 2021 to seven (41%) districts in 2022 classified as hard-to-reach. The combined risk stratification identified that most districts in Cabo Delgado province had medium to high-risk (n = 7; 41%); very high-risk (n = 5, 29%); medium risk (n = 3, 18%); high-risk (n = 2, 12%). CONCLUSION Most of the districts of Cabo Delgado were considered to be at risk of not meeting the neglected tropical diseases road map 2030 targets due to the humanitarian crisis ongoing. There is the need for practical strategies and funding to overcome these hostile challenges.
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Affiliation(s)
| | - Henis Mior Sitoe
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Maputo, Mozambique
| | - Sergio Lopes
- The MENTOR Initiative, Haywards Heath, United Kingdom
| | - Louise A. Kelly-Hope
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, United Kingdom
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Baayenda G, Opon R, Waititu T, Kabona G. 'Follow the cattle': a joint cross-border trachoma MDA perspective. Int Health 2023; 15:ii68-ii72. [PMID: 38048373 PMCID: PMC10695424 DOI: 10.1093/inthealth/ihad089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/30/2023] [Accepted: 09/12/2023] [Indexed: 12/06/2023] Open
Abstract
Trachoma, a disease caused by Chlamydia trachomatis, is the leading infectious cause of blindness. To fight it, endemic East African countries adopted the World Health Organization's SAFE Strategy, targeting surgery, antibiotics through mass drug administration (MDA), facial cleanliness and environmental improvement. Trachoma persists among nomadic communities along the Kenya-Uganda and Kenya-Tanzania borders. To address this, Kenya, Tanzania and Uganda launched synchronized MDA campaigns, simultaneously treating populations across borders. Successes included joint planning, community involvement and intergovernmental cooperation, although challenges remained in resourcing MDA cross-border focal points and in addressing coverage and funding. Novel strategies like synchronized joint cross-border MDA with community engagement are vital for sustainable trachoma elimination in these nomadic settings.
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Kishiki E, Kabona G, Mwangi G, Mkocha H, Shija F, Courtright P, Geneau R. Understanding the Role of Gender in Trichiasis Case Finding in Tanzania. Ophthalmic Epidemiol 2023:1-8. [PMID: 37622668 DOI: 10.1080/09286586.2023.2248628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/12/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Despite the importance of trachomatous trichiasis (TT) case-finding activities in national trachoma elimination campaigns, the scientific literature on the determinants of good outcomes - finding and managing all TT cases - is still sparse. In Tanzania, we studied differences in case finding activities and outcomes between male and female case finders. METHODS This case study was conducted in two districts in Tanzania in 2021-2022. Quantitative data were extracted from case finder forms and outreach registers, and qualitative data were collected through direct observation, interviews, and focus group discussions. RESULTS Across both districts, more males were trained as case finders (68%). Productivity differences were minor, not statistically significant, between male and female case finders regarding the number of households visited and the number of adults examined. Whether identified by a male or female case finder, similar proportions of men and women suspected to have TT were subsequently managed. There is evidence that suggests that female case finders were more active in supporting suspected and confirmed TT cases to access follow-up services. CONCLUSION The findings do not suggest that gender balance in the recruitment of TT case finders would have led to better TT campaign outcomes in the study districts. Programmes may benefit from integrating gender considerations in the design and implementation of case finding activities - e.g. in monitoring gender differences among case finders and the relationship with key outcomes. This study also highlights how women with TT face greater barriers to care.
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Affiliation(s)
| | - George Kabona
- Neglected Tropical Diseases Control Program, Ministry of Health, Dar es salaam, Tanzania
| | - Grace Mwangi
- Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania
| | | | - Fortunate Shija
- Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania
| | - Paul Courtright
- Sightsavers, Haywards Heath, UK
- Division of ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Robert Geneau
- Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania
- Division of ophthalmology, University of Cape Town, Cape Town, South Africa
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Maritim P, Chewe M, Munakaampe MN, Silumbwe A, Sichone G, Zulu JM. Applying community health systems lenses to identify determinants of access to surgery among mobile & migrant populations with hydrocele in Zambia: A mixed methods assessment. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002145. [PMID: 37463160 DOI: 10.1371/journal.pgph.0002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/15/2023] [Indexed: 07/20/2023]
Abstract
Hydrocele which is caused by long term lymphatic filariasis infection can be treated through the provision of surgery. Access to surgeries remains low particularly for hard to reach populations. This study applied community health system lenses to identify determinants to the adoption, implementation and integration of hydrocele surgeries among migrants &mobile populations in Luangwa District, Zambia. A concurrent mixed methods design consisting of cross-sectional survey with hydrocele patients (n = 438) and in-depth interviews with different community actors (n = 38) was conducted in October 2021. Data analysis was based on the relational and programmatic lenses of Community Health Systems. Under the Programmatic lens, insufficient resources resulted in most health facilities being incapable of providing the minimum package of care for lymphatic filariasis. The absence of cross border collaborative structures limits the continuity of care for patients moving across the three countries. Other programmatic barriers include language barriers, inappropriate appointment systems, direct and indirect costs. In the relational lens, despite the key role that community leaders play their engagement in service delivery was low. Community actors including patients were rarely included in planning, implementation or evaluation of hydrocele services. Some patients utilized their power within to act as champions for the surgery but local groups such as fishing associations remained underutilized. Community health systems provide a potential avenue through which access amongst mobile and migrant populations can be enhanced through strategies such engagement of patient groups, knowledge sharing across borders and use of community monitoring initiatives.
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Affiliation(s)
- Patricia Maritim
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mwimba Chewe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Margarate Nzala Munakaampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Adam Silumbwe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - George Sichone
- Participatory Research and Innovations Management, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
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Kelly-Hope LA, Harding-Esch EM, Willems J, Ahmed F, Sanders AM. Conflict-climate-displacement: a cross-sectional ecological study determining the burden, risk and need for strategies for neglected tropical disease programmes in Africa. BMJ Open 2023; 13:e071557. [PMID: 37197807 DOI: 10.1136/bmjopen-2023-071557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Complex challenges such as political instability, climate change and population displacement are increasing threats to national disease control, elimination and eradication programmes. The objective of this study was to determine the burden and risk of conflict-related and climate-related internal displacements and the need for strategies for countries endemic with neglected tropical diseases (NTDs). DESIGN, SETTING AND OUTCOME MEASURES A cross-sectional ecological study was conducted including countries that are endemic with at least one of five NTDs requiring preventive chemotherapy in the African region. For each country, the number of NTDs, population size and the number and rate per 100 000 of conflict-related and natural disaster-related internal displacements reported in 2021 were classified into high and low categories and used in unison to stratify and map the burden and risk. RESULTS This analysis identified 45 NTD-endemic countries; 8 countries were co-endemic with 4 or 5 diseases and had populations classified as 'high' totalling >619 million people. We found 32 endemic countries had data on internal displacements related to conflict and disasters (n=16), disasters only (n=15) or conflict only (n=1). Six countries had both high conflict-related and disaster-related internal displacement numbers totalling >10.8 million people, and five countries had combined high conflict-related and disaster-related internal displacement rates, ranging from 770.8 to 7088.1 per 100 000 population. Weather-related hazards were the main cause of natural disaster-related displacements, predominately floods. CONCLUSIONS This paper presents a risk stratified approach to better understand the potential impact of these complex intersecting challenges. We advocate for a 'call to action' to encourage national and international stakeholders to further develop, implement and evaluate strategies to better assess NTD endemicity, and deliver interventions, in areas at risk of, or experiencing, conflict and climate disasters, in order to help meet the national targets.
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Affiliation(s)
- Louise A Kelly-Hope
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Johan Willems
- CBM Christoffel-Blindenmission Christian Blind Mission e.V, Bensheim, Germany
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Zoerhoff KL, Mbabazi PS, Gass K, Kraemer J, Fuller BB, Blair L, Bougma R, Meite A, Negussu N, Gashaw B, Nash SD, Biritwum NK, Lemoine JF, Ullyartha Pangaribuan H, Wijayanti E, Kollie K, Rasoamanamihaja CF, Juziwelo L, Mkwanda S, Rimal P, Gnandou I, Diop B, Dorkenoo AM, Bronzan R, Tukahebwa EM, Kabole F, Yevstigneyeva V, Bisanzio D, Courtney L, Koroma J, Endayishimye E, Reithinger R, Baker MC, Fleming FM. How well do coverage surveys and programmatically reported mass drug administration coverage match? Results from 214 mass drug administration campaigns in 15 countries, 2008-2017. BMJ Glob Health 2023; 8:e011193. [PMID: 37142297 PMCID: PMC10163531 DOI: 10.1136/bmjgh-2022-011193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/18/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Delivering preventive chemotherapy through mass drug administration (MDA) is a central approach in controlling or eliminating several neglected tropical diseases (NTDs). Treatment coverage, a primary indicator of MDA performance, can be measured through routinely reported programmatic data or population-based coverage evaluation surveys. Reported coverage is often the easiest and least expensive way to estimate coverage; however, it is prone to inaccuracies due to errors in data compilation and imprecise denominators, and in some cases measures treatments offered as opposed to treatments swallowed. OBJECTIVE Analyses presented here aimed to understand (1) how often coverage calculated using routinely reported data and survey data would lead programme managers to make the same programmatic decisions; (2) the magnitude and direction of the difference between these two estimates, and (3) whether there is meaningful variation by region, age group or country. METHODS We analysed and compared reported and surveyed treatment coverage data from 214 MDAs implemented between 2008 and 2017 in 15 countries in Africa, Asia and the Caribbean. Routinely reported treatment coverage was compiled using data reported by national NTD programmes to donors, either directly or via NTD implementing partners, following the implementation of a district-level MDA campaign; coverage was calculated by dividing the number of individuals treated by a population value, which is typically based on national census projections and occasionally community registers. Surveyed treatment coverage came from post-MDA community-based coverage evaluation surveys, which were conducted as per standardised WHO recommended methodology. RESULTS Coverage estimates using routine reporting and surveys gave the same result in terms of whether the minimum coverage threshold was reached in 72% of the MDAs surveyed in the Africa region and in 52% in the Asia region. The reported coverage value was within ±10 percentage points of the surveyed coverage value in 58/124 of the surveyed MDAs in the Africa region and 19/77 in the Asia region. Concordance between routinely reported and surveyed coverage estimates was 64% for the total population and 72% for school-age children. The study data showed variation across countries in the number of surveys conducted as well as the frequency with which there was concordance between the two coverage estimates. CONCLUSIONS Programme managers must grapple with making decisions based on imperfect information, balancing needs for accuracy with cost and available capacity. The study shows that for many of the MDAs surveyed, based on the concordance with respect to reaching the minimum coverage thresholds, the routinely reported data were accurate enough to make programmatic decisions. Where coverage surveys do show a need to improve accuracy of routinely reported results, NTD programme managers should use various tools and approaches to strengthen data quality in order to use data for decision-making to achieve NTD control and elimination goals.
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Affiliation(s)
- Kathryn L Zoerhoff
- International Development Group, RTI International, Washington, District of Columbia, USA
- The Task Force for Global Health, Decatur, Georgia, USA
| | | | | | - John Kraemer
- School of Health, Georgetown University, Washington, District of Columbia, USA
| | - Brian B Fuller
- International Development Group, RTI International, Washington, District of Columbia, USA
- Helen Keller International, New York, New York, USA
| | | | - Roland Bougma
- Ministère de la Santé et de l'Hygiène Publique, Ouagadougou, Burkina Faso
| | - Aboulaye Meite
- Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Nebiyu Negussu
- Federal Ministry of Health, Addis Ababa, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | | | | | - Pradip Rimal
- Ministry of Health and Population, Kathmandu, Nepal
| | - Issa Gnandou
- Ministère de la Santé Publique, de la Population, et des Affaires Sociales, Niamey, Niger
| | - Bocar Diop
- Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Ameyo Monique Dorkenoo
- Ministère de la Santé, de l'Hygiène Publique, et de l'Accès Universel aux Soins, Lomé, Togo
| | | | | | - Fatima Kabole
- Zanzibar Ministry of Health, Stone Town, Tanzania, United Republic of
| | | | - Donal Bisanzio
- International Development Group, RTI International, Washington, District of Columbia, USA
| | - Lauren Courtney
- International Development Group, RTI International, Washington, District of Columbia, USA
| | | | | | - Richard Reithinger
- International Development Group, RTI International, Washington, District of Columbia, USA
| | - Margaret C Baker
- International Development Group, RTI International, Washington, District of Columbia, USA
- School of Health, Georgetown University, Washington, District of Columbia, USA
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Koirala T, B C UB, Shrestha C, Paudel U, Dhital R, Pokharel S, Subedi M. Arterial hypertension and its covariates among nomadic Raute hunter-gatherers of Western Nepal: a mixed-method study. BMJ Open 2023; 13:e067312. [PMID: 36997254 PMCID: PMC10069499 DOI: 10.1136/bmjopen-2022-067312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES To determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal. DESIGN A mixed-method study. SETTING The study was carried out at Raute temporary campsites in the Surkhet District of Karnali Province between May and September 2021. PARTICIPANTS The questionnaire-based survey included all males and non-pregnant females of the nomadic Raute group aged 15 years and above. In-depth interviews were conducted among purposively selected 15 Raute participants and four non-Raute key informants to help explain and enrich the quantitative findings. OUTCOME MEASURES The prevalence of hypertension (defined as brachial artery blood pressure of systolic ≥140 mm Hg and/or diastolic ≥90 mm Hg) and its sociodemographic, anthropometric and behavioural covariates. RESULTS Of the 85 eligible participants, 81 (median age 35 years (IQR: 26-51), 46.9% female) were included in the final analysis. Hypertension was found in 10.5% of females, 48.8% of males and 30.9% of the total population. Current alcohol and tobacco use were high (91.4% and 70.4%, respectively), with concerning high rates among youths. Males, older people, current drinkers and current tobacco users were more likely to have hypertension. Our qualitative analysis suggests that the traditional forest-based Raute economy is gradually transitioning into a cash-based one that heavily relies on government incentives. Consumption of commercial foods, drinks and tobacco products is increasing as their market involvement grows. CONCLUSION This study found a high burden of hypertension, alcohol and tobacco use among nomadic Raute hunter-gatherers facing socioeconomic and dietary transitions. Further research is needed to assess the long-term impact of these changes on their health. This study is expected to help appraise concerned policymakers of an emerging health concern and formulate context-specific and culturally sensitive interventions to limit hypertension-related morbidities and mortalities in this endangered population.
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Affiliation(s)
- Tapendra Koirala
- Dasharathpur Primary Health Care Center, Surkhet, Karnali Province, Nepal
- Department of Health Services, Ministry of Health and Population, Kathmandu, Bagmati Province, Nepal
| | - Udaya Bahadur B C
- Public Health Service Office Surkhet, Ministry of Social Development, Surkhet, Karnali Province, Nepal
| | - Carmina Shrestha
- Health Action and Research Pvt. Ltd, Kathmandu, Bagmati Province, Nepal
| | - Ujjawal Paudel
- Department of Health Services, Ministry of Health and Population, Kathmandu, Bagmati Province, Nepal
- Jibjibe Primary Health Care Center, Rasuwa, Bagmati Province, Nepal
| | - Rolina Dhital
- Health Action and Research Pvt. Ltd, Kathmandu, Bagmati Province, Nepal
| | - Sunil Pokharel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Madhusudan Subedi
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Bagmati Province, Nepal
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Paramesti SI, Rejeki DSS, Wijayanti SPM, Nurlaela S, Octaviana D, Wijayanto B. Migration Surveillance as a Maintenance Effort of Malaria Elimination Status (Study in Banyumas Regency, Central Java, Indonesia, 2021). Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Banyumas Regency is a malaria-receptive area with the occurrence of imported cases, particularly in sub-districts with the potential for transmission and even extraordinary events. To eliminate malaria in the regency, Migration surveillance is needed. Therefore, this study aims to evaluate implementing a malaria migration surveillance system to maintain its elimination status in Banyumas Regency in 2021.
Method: This qualitative case study was conducted in Banyumas Regency with a total of 9 informants consisting of 2 people from the Health Office, 4 from the Community Health Center, 2 from the Health Laboratory, and 1 village head. Data was collected through Forum Group Discussions, in-depth interviews, and secondary data through document review. This study also adopted content analysis with a thematic network approach.
Result: There are several limitations to implementing malaria migration surveillance, namely the lack of human resources, ineffective implementation of village regulations, and the lack of public awareness in reporting symptoms of malaria. Therefore, comprehensive training, policies socialization, improved partnerships, and application-based village reporting are required to maintain the elimination of migration surveillance.
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