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Donovan L, Shafique M, Wharton-Smith A, Richardson S, Viganò E, Traore A, Compaoré C, Tounaikok N, Honoré B, Dingamtel N, Awokou F, Sewu E, Tougri G, Diar MSI, Atcha-Oubou T, Ward C, Baker K. Using the role model approach to optimise caregiver administration of sulfadoxine-pyrimethamine amodiaquine to children aged 3-59 months in Burkina Faso, Chad and Togo: findings from an evaluation. Malar J 2024; 23:255. [PMID: 39180068 PMCID: PMC11344284 DOI: 10.1186/s12936-024-05067-x] [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: 03/13/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) is a World Health Organization-recommended intervention for the prevention of malaria among children at high risk in areas with seasonal transmission. During the coronavirus disease 2019 (COVID-19) pandemic, SMC drug distribution was rapidly adapted to reduce contact and mitigate the risk of transmission between communities and community distributors, with caregivers administering doses. To address the challenges and find local solutions to improve administration and adherence, the role model approach was designed, implemented and evaluated in selected communities of Burkina Faso, Chad and Togo. This paper describes the results of this evaluation. METHODS Focus group discussions were held with primary caregivers in all three countries to understand their perceptions of the approach's acceptability and feasibility. In Burkina Faso and Togo, household surveys assessed the characteristics of caregivers reached by role model activities. Key indicators on SMC coverage and adherence allowed for an assessment of caregiver engagement outcomes related to participation in activities. Statistical associations between participation in study's activities and caregiver beliefs related to SMC had been tested. RESULTS The majority of caregivers believed the approach to have a positive effect on drug administration, with most adopting the promoted strategies. Greater involvement of fathers in drug administration and acknowledgement of their joint responsibility was a notable positive outcome. However, several barriers to participation were noted and there was criticism of the group approach. In Burkina Faso and Togo, end-of-round survey results revealed that 98.4% of respondents agreed the approach improved their knowledge and skills in malaria prevention, while 100% expressed a desire to continue practicing the behaviours learned. However, there was a relatively low level of awareness of the approach among communities. Participation was strongly associated with participants' self-reported belief in ease of remembering to administer, and ease of administering, SMC medicines. CONCLUSION Caregivers perceived the role model approach to be beneficial in aiding drug administration, with other positive impacts also reported. Replication and scale-up should utilize the most popular communication channels and existing community structures to ensure activities are promoted effectively. A mixture of group and one-on-one approaches should be used where appropriate and feasible.
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Affiliation(s)
| | | | | | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | | | | | | | | | | | | | | | - Gauthier Tougri
- National Malaria Control Programme, Ouagadougou, Burkina Faso
| | | | | | - Charlotte Ward
- London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin Baker
- Malaria Consortium, London, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Seifu BL, Tesema GA, Tebeje T, Legesse BT, Yehuala TZ, Wuneh AG, Tadese ZB, Mare KU. Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design. BMJ Open 2024; 14:e074477. [PMID: 38663921 PMCID: PMC11043768 DOI: 10.1136/bmjopen-2023-074477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Low haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin concentration. However, there is limited research on the prevalence and determinants of normal haemoglobin concentration among under-five children in sub-Saharan Africa. OBJECTIVE To assess determinants of normal haemoglobin concentration among under-five children in SSA. DESIGN Cross-sectional study design using a positive deviance approach SETTING: 33 SSA countries. PARTICIPANTS 129 408 children aged 6-59 months PRIMARY AND SECONDARY OUTCOME MEASURES: A multilevel Poisson regression model with robust variance was fitted to identify determinants of normal haemoglobin concentration. An adjusted prevalence ratio with a 95% CI was reported to declare the statistical significance. RESULT The pooled prevalence of normal haemoglobin concentration among under-five children in SSA was 34.9% (95% CI: 34.6% to 35.1%). High maternal education, middle and rich household wealth, female child, frequent antenatal care visits, non-anaemic mothers, taking anthelmintic drugs and normal nutritional status were associated with increased odds of normal haemoglobin concentration. On the other hand, higher birth order, having fever and diarrhoea, rural residence were associated with lower odds of normal haemoglobin levels. CONCLUSION According to our finding, only four out of 10 under-five children in SSA had a normal haemoglobin level. This finding proved that anaemia among children in SSA remains a serious public health concern. Therefore, improving maternal education, provision of drugs for an intestinal parasite and early detection and treatment of maternal anaemia, febrile illness and diarrhoeal disease is important.
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Affiliation(s)
- Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Tsion Tebeje
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institutes of Health Science, Wollega University, Nekemte, Ethiopia
| | - Tirualem Zeleke Yehuala
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Abel Gebre Wuneh
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | | | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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3
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Rahman MM, Tanni KN, Roy T, Islam MR, Al Raji Rumi MA, Sadman Sakib M, Abdul Quader M, Bhuiyan NUI, Shobuj IA, Sayara Rahman A, Haque MI, Faruk F, Tahsan F, Rahman F, Alam E, Md. Towfiqul Islam AR. Knowledge, Attitude and Practices Towards Dengue Fever Among Slum Dwellers: A Case Study in Dhaka City, Bangladesh. Int J Public Health 2023; 68:1605364. [PMID: 37284509 PMCID: PMC10239854 DOI: 10.3389/ijph.2023.1605364] [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: 09/01/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives: This study intends to evaluate Dhaka city slum dwellers' responses to Dengue fever (DF). Methods: 745 individuals participated in a KAP survey that was pre-tested. Face-to-face interviews were performed to obtain data. Python with RStudio was used for data management and analysis. The multiple regression models were applied when applicable. Results: 50% of respondents were aware of the deadly effects of DF, its common symptoms, and its infectious nature. However, many were unaware that DF could be asymptomatic, a previously infected person could have DF again, and the virus could be passed to a fetus. Individuals agreed that their families, communities, and authorities should monitor and maintain their environment to prevent Aedes mosquito breeding. However, overall 60% of the study group had inadequate preventative measures. Many participants lacked necessary practices such as taking additional measures (cleaning and covering the water storage) and monitoring potential breeding places. Education and types of media for DF information were shown to promote DF prevention practices. Conclusion: Slum dwellers lack awareness and preventative activities that put them at risk for DF. Authorities must improve dengue surveillance. The findings suggest efficient knowledge distribution, community stimulation, and ongoing monitoring of preventative efforts to reduce DF. A multidisciplinary approach is needed to alter dwellers' behavior since DF control can be done by raising the population's level of life. People and communities must perform competently to eliminate vector breeding sites.
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Affiliation(s)
- Md. Mostafizur Rahman
- Department of Disaster Management and Resilience, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Kamrun Nahar Tanni
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Tuly Roy
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Md. Rakibul Islam
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Md. Alim Al Raji Rumi
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Mohammed Sadman Sakib
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Masrur Abdul Quader
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Nafee-Ul-Islam Bhuiyan
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Ifta Alam Shobuj
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Afra Sayara Rahman
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Md. Iftekharul Haque
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Fariha Faruk
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Fahim Tahsan
- Department of Disaster and Human Security Management, Faculty of Arts and Social Sciences, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Farzana Rahman
- Department of Computer Science and Engineering, Independent University, Bangladesh, Dhaka, Bangladesh
| | - Edris Alam
- Faculty of Resilience, Rabdan Academy, Abu Dhabi, United Arab Emirates
- Department of Geography and Environmental Studies, University of Chittagong, Chittagong, Bangladesh
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Phok S, Tesfazghi K, Tompsett A, Thavrine B, Ly P, Hassan SED, Avrakotos A, Malster J, Felker-Kantor E. Behavioural determinants of malaria risk, prevention, and care-seeking behaviours among forest-goers in Cambodia. Malar J 2022; 21:362. [PMID: 36457085 PMCID: PMC9716661 DOI: 10.1186/s12936-022-04390-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cambodia has made significant progress towards achieving malaria elimination by 2025. Cases continue to decrease and are primarily concentrated in forested areas. Forest-goers are most at risk of malaria due to their proximity to the forest, poor sleeping conditions, frequent mobility, and distance from health services. Consistent use of long-lasting insecticidal nets or hammock nets (LLINs/LLIHNs), early diagnosis and treatment of cases are central to reducing disease burden. The aim of this study was to understand forest-goers' knowledge, attitudes, and practices related to malaria prevention and care-seeking, and to identify key behavioural determinants of LLIN/LLIHN use and prompt care-seeking within 24 h of developing a fever. METHODS A mixed-methods study design consisting of a cross-sectional survey and qualitative in-depth interviews was implemented in two Cambodian provinces. Survey participants (N = 654) were recruited using respondent driven sampling. Interview participants (N = 28) were selected using purposive sampling. Findings from the survey were analysed using univariate and bivariate analysis and multivariate weighted logistic regression. Interviews were coded and analysed using thematic content analysis. RESULTS All study participants had heard of malaria and 98% knew that malaria was transmitted by mosquitoes. LLIN/LLIHN ownership was high (94%). Although 99% of participants perceived LLIN/LLIHN use as an important malaria prevention measure, only 76% reported using one during their last visit to the forest. Only 39% of survey participants who reported seeking care did so within the recommended 24 h from fever onset during their last febrile illness. Among all study participants, 43% did not seek any healthcare during their last febrile episode. In controlled regression models, perceived community social norms were significantly associated with LLIN/LLIHN use (OR: 2.7, 96% CI 1.99-2.64) and care-seeking within 24 h of fever onset (OR: 1.7, 95% CI 1.00-2.88). Social support from other forest-goers was also significantly associated with LLIN/LLIHN use (OR: 4.9, 95% CI 1.32-18.12). CONCLUSIONS Study findings are consistent with other studies on LLIN/LLIHN use and care-seeking behaviours. While rates of LLIN/LLIHN ownership were high among the study population, rates of use were not as high. More concerning were the delayed care-seeking behaviours. Social behaviour change activities should incorporate social norms and social support as mechanisms for behaviour change given the identified positive correlations with LLIN/LLIHN use and prompt care-seeking.
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Affiliation(s)
- Sochea Phok
- Population Services International, Phnom Penh, Cambodia
| | - Kemi Tesfazghi
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
| | - Andy Tompsett
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
| | - Boukheng Thavrine
- grid.452707.3National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Po Ly
- grid.452707.3National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Saad El-Din Hassan
- US President’s Malaria Initiative, United States Agency for International Development, Phnom Penh, Cambodia
| | - Avery Avrakotos
- grid.420285.90000 0001 1955 0561US President’s Malaria Initiative, United States Agency for International Development, Washington, DC USA
| | - Jim Malster
- Population Services International, Phnom Penh, Cambodia
| | - Erica Felker-Kantor
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
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Basic determinants of child linear growth outcomes in sub-Saharan Africa: a cross-sectional survey analysis of positive deviants in poor households. Sci Rep 2022; 12:14218. [PMID: 35987958 PMCID: PMC9392732 DOI: 10.1038/s41598-022-18568-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Childhood malnutrition is a significant public health problem confronting countries across the globe. Although there is evidence of a downward trend in undernutrition globally, sub-Saharan Africa did not experience significant improvement in the past decades. This study investigated the basic determinants of linear growth among children living in poor households. We analysed a nationally representative sample of children aged 0–59 months (N = 24,264). The study countries were Ghana, Kenya, the Democratic Republic of Congo (DRC), Nigeria, and Mozambique. The child’s height-for-age Z-scores (HAZ), categorised into HAZ > − 2 standard deviations (SD) (not stunted) and HAZ < − 2 SD (stunted) was the outcome variable of interest. We used logistic regression as our analytical strategy. In DRC, Ghana, Kenya and Nigeria, maternal years of schooling was associated with positive linear growth among children living in poor households. In Ghana and DRC, four antenatal visits had a positive effect on better linear growth, while in Nigeria, healthy maternal body mass index (kg/m2) had a positive effect on child's linear growth. The putative socio-demographic determinants investigated in our study can promote the linear growth of children living in poor households. Interventions aimed at fostering linear growth among children living in poverty should focus on enhancing these factors.
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Narrative Review of the Control and Prevention of Knowlesi Malaria. Trop Med Infect Dis 2022; 7:tropicalmed7080178. [PMID: 36006270 PMCID: PMC9414718 DOI: 10.3390/tropicalmed7080178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the reduction in the number of cases of human malaria throughout the world, the incidence rate of knowlesi malaria is continuing to rise, especially in Southeast Asia. The conventional strategies for the prevention and control of human malaria can provide some protection against knowlesi malaria. Despite the numerous studies on the risk factors and the innovative methods that may be used to prevent and control the vectors of Plasmodium knowlesi, the incidence rate remains high. An integrated approach that includes environmental intervention should be adopted in order to ensure the successful control of zoonotic malaria. A combination of personal-level protection, vector control and environmental control may mitigate the risk of Plasmodium knowlesi transmission from macaques to humans and, ultimately, reduce the incidence rate of knowlesi malaria.
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Foster BA, Seeley K, Davis M, Boone-Heinonen J. Positive deviance in health and medical research on individual level outcomes - a review of methodology. Ann Epidemiol 2022; 69:48-56. [PMID: 34915122 PMCID: PMC9081135 DOI: 10.1016/j.annepidem.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Positive deviance as a methodology is increasing in application yet there is high variability in how this approach is applied in health services research. METHODS We conducted a scoping review of the literature for positive deviance applied to health outcomes informed by PRISMA-ScR. We searched the literature from 1945 to 2020, including articles on positive deviance or positive outliers, and restricted to examining individual rather than organizational outcomes. We analyzed the methodology applied including the process of identifying deviants, the use of control groups, and the degree of community engagement. RESULTS Our initial search identified 1140 manuscripts; we included 104 papers describing 98 studies, 11 topical and one miscellaneous category. Most studies used objective measures of health or survey-based responses to identify deviants from a sub-set of the population at risk. The use of controls was less common in some topics (hospital infections), whereas controls were universally applied in other topics (malnutrition). The degree of community engagement varied widely. CONCLUSIONS Positive deviance would benefit from improvements in reporting and standardized approaches to defining deviance. Studies could be improved through clarified definitions of deviance/risk, explicit descriptions of community engagement, and more consistent use of controls.
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Affiliation(s)
- Byron A Foster
- Department of Pediatrics, Oregon Health & Science University, Portland, OR; School of Public Health, Portland State University and Oregon Health & Science University.
| | - Kylie Seeley
- Department of Pediatrics, Stanford University, Stanford School of Medicine, Palo Alto, CA
| | - Melinda Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Janne Boone-Heinonen
- School of Public Health, Portland State University and Oregon Health & Science University
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Shafique M, Mukhtar M, Areesantichai C, Perngparn U. Effectiveness of Positive Deviance, an Asset-Based Behavior Change Approach, to Improve Knowledge, Attitudes, and Practices Regarding Dengue in Low-Income Communities (Slums) of Islamabad, Pakistan: A Mixed-Method Study. INSECTS 2022; 13:insects13010071. [PMID: 35055914 PMCID: PMC8780378 DOI: 10.3390/insects13010071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Dengue is a mosquito-borne infection caused by the Aedes mosquito, expanding at an alarming pace around the world. Recently, Pakistan has witnessed some major dengue outbreaks, affecting thousands of individuals across the country. As there is no specific cure or vaccine, prevention and vector control remain the key methods to avoid dengue infection. In Pakistan, dengue control activities are mainly focused on information-sharing through mass media and communication materials such as pamphlets and posters. The main challenge is a lack of community participation that can create an enabling environment for communities to follow the desired behaviors. There is a strong need to design and implement community-led behavior change approaches to ensure community participation and translate the knowledge into practices. This study was conducted to better understand the effectiveness of a community engagement approach, ‘positive deviance’, on dengue prevention and control. The study was carried out in two slums affected by the recent dengue outbreak in Islamabad, Pakistan. A total of 112 persons participated in the study, which was conducted from June–October 2020. The community discovered already-existing positive behaviors surrounding dengue prevention and control, which were shared with other participants through interactive activities. The study demonstrated positive changes in knowledge, attitudes, and practices, and could be a potential tool for dengue prevention and control programs worldwide. Abstract Dengue is a mosquito-borne, viral disease that has emerged as a global health concern in recent years. In the absence of specific antiviral treatment and vaccines, prevention remains the key strategy for dengue control. Therefore, innovative and community-driven approaches are required to improve the vector control practices. This study applied and evaluated the positive deviance (PD) approach on dengue prevention and control in selected slums of Islamabad during June–October 2020. The two most dengue-affected slums, the Faisal colony and France colony, were purposively selected as intervention and control groups, respectively. A total of 112 participants (56 for the intervention and 56 for the control group) participated in the study. The intervention group was exposed for two months to locally identified role model behaviors through weekly interactive sessions, dengue sketch competitions, and role plays. Another two months enabled the community to practice these behaviors without any external support in order to explore the intervention’s sustainability. Three surveys were conducted: before the intervention, after two months, and after four months, to assess any changes in the knowledge, attitudes, and practices of participating communities. Results found that the PD intervention had a significant positive impact on dengue knowledge, attitudes, and practices in the intervention group. PD could offer an empowering and efficient community engagement tool for future dengue prevention and control, both in Pakistan and more globally.
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Affiliation(s)
- Muhammad Shafique
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (M.S.); (C.A.)
| | | | - Chitlada Areesantichai
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (M.S.); (C.A.)
- Health and Social Science and Addiction Research Unit (HSSRU), Bangkok 10330, Thailand
| | - Usaneya Perngparn
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (M.S.); (C.A.)
- Correspondence:
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Murta FLG, Marques LLG, Santos APC, Batista TSB, Mendes MO, Silva ED, Neto AVS, Fabiano M, Rodovalho SR, Monteiro WM, Lacerda MVG. Perceptions about malaria among Brazilian gold miners in an Amazonian border area: perspectives for malaria elimination strategies. Malar J 2021; 20:286. [PMID: 34174880 PMCID: PMC8236171 DOI: 10.1186/s12936-021-03820-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background Mining in the Amazon exposes gold miners to various diseases, including malaria, whose control is still a major challenge. The environment of the mines contributes to the proliferation of vector mosquitoes and the precarious housing conditions facilitate transmission of the disease. Understanding gold miners’ perceptions is essential for the formulation of strategies to fight malaria. A qualitative study was carried out in the municipality of Calçoene, state of Amapá, Brazilian Amazon adjointining the municipality of Oiapoque, that is in the border area with French Guiana and Suriname. Methods A semi-structured interview was applied to an intentional sample of 29 miners, a number determined by the theoretical saturation criterion. Thematic analysis was adopted to obtain the results and the Cohen's Kappa index was calculated to verify the agreement between observers during coding. Results The agreement between observers was verified by a Cohen's Kappa index of 0.82. Analysis of the interviews showed that gold miners were subjected to prejudice from the community due to forest diseases that they can transmit, and their activities are often associated with crime. When the miners return to their hometown after a period of mining, the urban population blames them for the onset of diseases such as malaria. Most participants in the survey did not know how malaria transmission occurs, and associated its occurrence with contaminated water and food. Participants reported not being afraid of the disease, trusting the diagnosis and available treatment, though this depends on where they are treated. The use of therapeutic resources, such as medicinal plants and medicines acquired in the illegal market, is very common in this population. Despite the challenges identified by the research subjects, they believe that the disease can be controlled, or the cases reduced, but there was low acceptability for a possible mass drug administration (MDA) intervention. Conclusion Despite a recent reduction in malaria prevalence in Brazil, there are still vulnerable populations, such as gold miners, who help to perpetuate the existence of the disease in the Amazon. The lack of knowledge regarding how the transmission of malaria occurs, associated with myths regarding this and the use of traditional health practices and illegal drugs for the treatment of the disease without a specific diagnosis, jeopardizes the country’s efforts to eliminate malaria. It is necessary to implement control programmes in these populations, especially those who frequently travel around the border region and to remote locations, which are difficult regions for health teams to access, thus hindering diagnostic and treatment actions. For this reason, understanding the perceptions of these individuals as well as their customs, beliefs and lifestyle, can assist in the production of targeted educational material and adoption of strategies in the elimination of malaria in the country. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03820-0.
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Affiliation(s)
- Felipe L G Murta
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil. .,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.
| | - Leonardo L G Marques
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Alicia P C Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Talita S B Batista
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Maxwell O Mendes
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Elair D Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Alexandre V S Neto
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Marcio Fabiano
- Fundação Para o Desenvolvimento Científico e Tecnológico em Saúde, Rio de Janeiro, Brazil
| | - Sheila R Rodovalho
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.,Pan American Health Organization - PAHO, World Health Organization, Brasilia, Brazil
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil
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10
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Amugsi DA. Determinants of normal haemoglobin concentration among children in Ghana: a positive deviance analysis of nationally representative cross-sectional survey data. Sci Rep 2020; 10:7175. [PMID: 32346023 PMCID: PMC7188845 DOI: 10.1038/s41598-020-64072-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/09/2020] [Indexed: 11/09/2022] Open
Abstract
Anaemia among children under 5, is a public health problem of serious concern. In Ghana, an estimated 8 out of every 10 children are anaemic. This study employed a novel approach to investigate the determinants of normal haemoglobin (Hb) concentration among children aged 6 to 59 months, using data from the Ghana Demographic and Health Surveys. The results showed that maternal schooling was positively associated with normal Hb concentration among children. Children of non-anaemic mothers were 1.67 (CI = 1.32, 2.10; P < 0.001) times more likely to have normal Hb concentration relative to children of anaemic mothers. Compared to mothers who had less than 4 antenatal care (ANC) visits, mothers who had at least 4 ANC visits increased the odds of their children having a normal Hb concentration by 1.62 (CI = 1.09, 2.40; P < 0.018). Children living in middle and rich households had respectively 1.48 (CI = 1.06, 2.07; p < 0.021) and 1.59 (CI = 1.08, 2.33; p < 0.018) increased odds of having a normal Hb concentration relative to those living in poor households. Maternal education, anaemia, ANC attendance, and household wealth index are strong determinants of normal Hb concentration among children in Ghana. Strategies aimed at addressing childhood anaemia should take into account maternal anaemia, education, poverty and ANC attendance.
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Affiliation(s)
- Dickson A Amugsi
- African Population and Health Research Center (APHRC), Nairobi, Kenya.
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11
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Identification and strengthening of positive deviance: An efforts to reduce the incidence of malaria in Selayar islands. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Sanann N, Peto TJ, Tripura R, Callery JJ, Nguon C, Bui TM, Nofal SD, von Seidlein L, Lek D, Dondorp AM, Cheah PY, Pell C. Forest work and its implications for malaria elimination: a qualitative study. Malar J 2019; 18:376. [PMID: 31771587 PMCID: PMC6880349 DOI: 10.1186/s12936-019-3008-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/16/2019] [Indexed: 11/11/2022] Open
Abstract
Background Over the last 20 years, malaria incidence has decreased across the Greater Mekong Sub-region (GMS) and the emergence of artemisinin resistance has stimulated efforts to accelerate regional elimination. In the GMS, the malaria transmission is focused increasingly in forested zones. This article describes forest-going activities and examines forest workers’ attitudes to and experiences of malaria prevention and control in north-eastern Cambodia. Methods In Stung Treng Province, Cambodia, 19 in-depth interviews were conducted in villages with participants recently diagnosed with uncomplicated falciparum malaria who reported working in forests. Two focus group discussions with respondents’ forest-working peers were held. Interviews and focus groups were audio-recorded transcribed, and translated for thematic analysis. Results Forest work is an essential source of income for respondents. Many combine it with farming, which influences the timing and duration of forest visits. Forest activities include logging and collecting other forest products, particularly malva nuts. Men log year-round, whereas gathering forest products is seasonal and can involve entire families. Forest workers sleep chiefly in unimpregnated hammock nets in make-shift encampments. Respondents are concerned about symptomatic malaria, but unfamiliar with the concept of asymptomatic infection. They view the forest as an area of potential malaria infection and seek to protect themselves from mosquito bites through wearing long-sleeved clothes, using repellents, and lighting fires. Forest workers express a willingness to self-test and self-administer anti-malarials. Conclusions Forest workers’ behaviour and perceptions of risk indicate that improvements are needed to current control measures. There is potential to: better target distribution of impregnated hammock nets; offer curative or presumptive treatment while in forests; and expand access to screening. Establishing the efficacy and feasibility of prophylaxis for forest workers in the GMS is a priority.
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Affiliation(s)
- Nou Sanann
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,University Research Company, Phnom Penh, Cambodia
| | - Thomas J Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - James J Callery
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chea Nguon
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Thanh Mai Bui
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Stephanie D Nofal
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Dysoley Lek
- National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,Centre for Social Sciences and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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13
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Murta FLG, Mendes MO, Sampaio VS, Junior ASB, Díaz-Bermúdez XP, Monteiro WM, Lacerda MVG. Misperceptions of patients and health workers regarding malaria elimination in the Brazilian Amazon: a qualitative study. Malar J 2019; 18:223. [PMID: 31272509 PMCID: PMC6611038 DOI: 10.1186/s12936-019-2854-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brazil has considerably reduced the number of cases of malaria in recent years and aims to eradicate the disease completely, however, vivax malaria continues to be a major challenge for the health system. In this context, the key to building a successful elimination programme may lie in the knowledge and the perceptions of the health agents, the patients affected by the disease and the personnel responsible for malaria diagnosis, treatment and control at the local level. METHODS A qualitative study was undertaken in Manaus, capital of the state of Amazonas, Western Brazilian Amazon, using a sample of 33 patients who were being treated for malaria and 22 health agents who were working in malaria diagnosis, treatment and control at the local level. A semi-structured interview with a further thematic analysis was performed. RESULTS There are still many myths regarding malaria transmission and treatment that may hinder the sensitization of the population of this region in relation to the use of current control tools and elimination strategies, such as mass drug administration (MDA). Most health professionals reported that the abandonment of treatment for malaria by the patient is related to poor social conditions, the high incidence of alcoholism and the low level of schooling of the affected population. One negative perception, observed in both groups with regard to the use of insecticide-treated nets, is that they may cause skin irritations and allergies. Most patients and health professionals have described malaria as an impossible disease to eliminate because it is intrinsically associated with forest landscapes, and according to them, elimination would only be possible if there were a vaccine against malaria. CONCLUSION In the Amazon, cultural perceptions about the etiology of this disease can influence the behaviour and practices that social groups adopt in relation to the different forms of living in a malaria-endemic context. Negative perceptions about malaria elimination can act as a barrier when trying to reach proper coverage for control strategies such as mosquito nets and MDA.
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Affiliation(s)
- Felipe Leão Gomes Murta
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil. .,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.
| | | | - Vanderson Souza Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | | | - Ximena Pamela Díaz-Bermúdez
- Departamento de Saúde Coletiva da Faculdade de Ciências da Saúde., Universidade de Brasília (UnB), Brasília, DF, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil
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14
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von Seidlein L, Peto TJ, Tripura R, Pell C, Yeung S, Kindermans JM, Dondorp A, Maude R. Novel Approaches to Control Malaria in Forested Areas of Southeast Asia. Trends Parasitol 2019; 35:388-398. [PMID: 31076353 DOI: 10.1016/j.pt.2019.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 12/27/2022]
Abstract
The emergence and spread of drug resistance in the Greater Mekong Subregion (GMS) have added urgency to accelerate malaria elimination while reducing the treatment options. The remaining foci of malaria transmission are often in forests, where vectors tend to bite during daytime and outdoors, thus reducing the effectiveness of insecticide-treated bed nets. Limited periods of exposure suggest that chemoprophylaxis could be a promising strategy to protect forest workers against malaria. Here we discuss three major questions in optimizing malaria chemoprophylaxis for forest workers: which antimalarial drug regimens are most appropriate, how frequently the chemoprophylaxis should be delivered, and how to motivate forest workers to use, and adhere to, malaria prophylaxis.
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Affiliation(s)
- Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Thomas J Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Sciences and Global Health, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Shunmay Yeung
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Arjen Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard Maude
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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15
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Pell CL, Adhikari B, Myo Thwin M, Kajeechiwa L, Nosten S, Nosten FH, Sahan KM, Smithuis FM, Nguyen TN, Hien TT, Tripura R, Peto TJ, Sanann N, Nguon C, Pongvongsa T, Phommasone K, Mayxay M, Mukaka M, Peerawaranun P, Kaehler N, Cheah PY, Day NPJ, White NJ, Dondorp AM, von Seidlein L. Community engagement, social context and coverage of mass anti-malarial administration: Comparative findings from multi-site research in the Greater Mekong sub-Region. PLoS One 2019; 14:e0214280. [PMID: 30908523 PMCID: PMC6433231 DOI: 10.1371/journal.pone.0214280] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 03/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Between 2013 and 2017, targeted malaria elimination (TME), a package of interventions that includes mass drug administration (MDA)-was piloted in communities with reservoirs of asymptomatic P. falciparum across the Greater Mekong sub-Region (GMS). Coverage in target communities is a key determinant of the effectiveness of MDA. Drawing on mixed methods research conducted alongside TME pilot studies, this article examines the impact of the community engagement, local social context and study design on MDA coverage. METHODS AND FINDINGS Qualitative and quantitative data were collected using questionnaire-based surveys, semi-structured and in-depth interviews, focus group discussions, informal conversations, and observations of study activities. Over 1500 respondents were interviewed in Myanmar, Vietnam, Cambodia and Laos. Interview topics included attitudes to malaria and experiences of MDA. Overall coverage of mass anti-malarial administration was high, particularly participation in at least a single round (85%). Familiarity with and concern about malaria prompted participation in MDA; as did awareness of MDA and familiarity with the aim of eliminating malaria. Fear of adverse events and blood draws discouraged people. Hence, community engagement activities sought to address these concerns but their impact was mediated by the trust relationships that study staff could engender in communities. In contexts of weak healthcare infrastructure and (cash) poverty, communities valued the study's ancillary care and the financial compensation. However, coverage did not necessarily decrease in the absence of cash compensation. Community dynamics, affected by politics, village conformity, and household decision-making also affected coverage. CONCLUSIONS The experimental nature of TME presented particular challenges to achieving high coverage. Nonetheless, the findings reflect those from studies of MDA under implementation conditions and offer useful guidance for potential regional roll-out of MDA: it is key to understand target communities and provide appropriate information in tailored ways, using community engagement that engenders trust.
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Affiliation(s)
- Christopher L. Pell
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Francois H. Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Sorbonne Universités, UPMC Univ Paris 06, UPMC UMRS CR7, Paris, France
| | - Kate M. Sahan
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Frank M. Smithuis
- Medical Action Myanmar, Yangon, Myanmar
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Thuy-Nhien Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Ho Chi Minh City, Vietnam
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Thomas J. Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nou Sanann
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chea Nguon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao PDR
- Institute of Research and Educational Development, University of Health Sciences, Vientiane, Lao PDR
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pimnara Peerawaranun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nils Kaehler
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Arjen M. Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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16
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Nofal SD, Peto TJ, Adhikari B, Tripura R, Callery J, Bui TM, von Seidlein L, Pell C. How can interventions that target forest-goers be tailored to accelerate malaria elimination in the Greater Mekong Subregion? A systematic review of the qualitative literature. Malar J 2019; 18:32. [PMID: 30709399 PMCID: PMC6359845 DOI: 10.1186/s12936-019-2666-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background Despite decreases in incidence and related mortality, malaria remains a major public health challenge in the Greater Mekong Sub-region (GMS). The emergence of artemisinin resistance threatens these gains and has prompted efforts to accelerate elimination in the region. In the GMS, transmission now clusters in hotspots along international borders and among high-risk populations, including forest-goers. To eliminate malaria in the region, interventions must target such hard-to-reach populations. This review provides a comprehensive overview of the qualitative research on behaviours and perceptions that influence uptake of and adherence to malaria interventions among forest-goers in the GMS. Methods A systematic search strategy was used to identify relevant sources, including database (OVID SP, PubMed, ISI Web of Knowledge) and bibliographic searches. Relevant findings from qualitative research methods were extracted and thematic analysis undertaken. Results Of 268 sources retrieved in searches twenty-two were reviewed. Most reported studies were conducted in Cambodia (n = 10), and were published after 2014 (n = 16). Four major themes emerged that are particularly relevant to the design of intervention packages targeted at forest-goers: (1) understanding of malaria and perceived risk; (2) preventive measures used when visiting the forest; (3) behaviours that put forest-goers at risk of infection; and, (4) malaria-related treatment seeking. There were notable differences across the reviewed articles that suggest the need for a locally tailored approach. Conclusion A more detailed characterization of forest activities is needed but research on this topic raises methodological challenges. Current vector control measures have limitations, with use of insecticidal-treated nets, hammocks and repellents influenced by the type of forest activities and the characteristics of these measures. In contrast, anti-malarial drugs, for example, as chemoprophylaxis, hold promise but require further evaluation. Electronic supplementary material The online version of this article (10.1186/s12936-019-2666-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie D Nofal
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas J Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - James Callery
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thanh Mai Bui
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Sciences and Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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17
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Abstract
Global health security is increasingly reliant on vigilance to provide early warning of transnational health threats. In theory, this approach requires that sentinels, based in communities most affected by new or reemerging infectious diseases, deliver timely alerts of incipient risk. Medicalizing global safety also implies there are particular forms of insecurity that must be remedied to preempt disease spread. I examine vigilance in the context of spreading drug-resistant malaria in Southeast Asian border zones and argue that to act as sentinels, marginal groups vulnerable to infection must be able to articulate what social and behavioral factors prompt proliferating disease risks.
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Affiliation(s)
- Chris Lyttleton
- a Department of Anthropology , Macquarie University , Sydney , NSW , Australia
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18
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Oliveira FTD, Ferreira MMF, Araújo STCD, Bessa ATTD, Moraes ACB, Stipp MAC. Positive deviance as a strategy to prevent and control bloodstream infections in intensive care. Rev Esc Enferm USP 2017; 51:e03212. [PMID: 28380162 DOI: 10.1590/s1980-220x2016182303212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/30/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. METHOD An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. RESULTS In 90 days, 188 actions were observed, of these, 36.70% (n=69) were related to catheter dressing. In 81.15% (n=56) of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. CONCLUSION Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care. OBJETIVO Descrever a aplicação do Positive Deviance como estratégia na prevenção e no controle da infecção de corrente sanguínea. MÉTODO Estudo de intervenção realizado na Unidade de Terapia Intensiva de um hospital universitário, com os membros das equipes de enfermagem e médica, de junho a dezembro de 2014. Foram aplicados os quatro passos da metodologia Positive Deviance: Definir, Determinar, Descobrir e Desenhar. RESULTADOS Em 90 dias 188 ações foram observadas, destas, 36,70% (n=69) estavam relacionadas aos curativos dos cateteres. Em 81,15% (n=56) desses curativos, o uso da haste flexível estéril para realização da antissepsia do local de inserção do cateter e de sua placa de fixação foi a ação de maior adesão. CONCLUSÃO O Positive Deviance auxiliou na implementação de propostas de melhorias de processo de trabalho e no desenvolvimento da equipe para os problemas identificados no cuidado com o cateter venoso central.
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Affiliation(s)
- Francimar Tinoco de Oliveira
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Médico-Cirúrgica, Rio de Janeiro, RJ, Brazil
| | - Maria Manuela Frederico Ferreira
- Escola Superior de Enfermagem de Coimbra, Conselho para a Qualidade e Avaliação da Unidade Científico Pedagógica de Enfermagem Fundamental, Coimbra, Portugal
| | - Silvia Teresa Carvalho de Araújo
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Médico-Cirúrgica, Rio de Janeiro, RJ, Brazil
| | | | - Advi Catarina Barbachan Moraes
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Médico-Cirúrgica, Rio de Janeiro, RJ, Brazil
| | - Marluci Andrade Conceição Stipp
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Metodologia da Enfermagem, Rio de Janeiro, RJ, Brazil
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19
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Crawshaw AF, Maung TM, Shafique M, Sint N, Nicholas S, Li MS, Roca-Feltrer A, Hii J. Acceptability of insecticide-treated clothing for malaria prevention among migrant rubber tappers in Myanmar: a cluster-randomized non-inferiority crossover trial. Malar J 2017; 16:92. [PMID: 28241830 PMCID: PMC5329906 DOI: 10.1186/s12936-017-1737-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/15/2017] [Indexed: 11/25/2022] Open
Abstract
Background Insecticide-treated clothing (ITC) has long been used for military and outdoor recreational purposes and there is substantial evidence to show that it can protect against arthropod biting. As a complementary vector control measure, ITC could be used to address outdoor transmission of malaria, particularly among mobile and migrant populations and night-time workers such as rubber tappers, who may be beyond the reach of core interventions. However, more information is required on acceptability and preferences of target groups towards ITC to understand whether it could be a viable strategy in Myanmar. Methods A cluster-randomized, double-blind, non-inferiority crossover trial was performed to determine acceptability of ITC versus identical, untreated clothing (NTC) among migrant rubber tappers. The study took place between January and May 2015 with 234 participants in 16 clusters in Thanbyuzayat Township, Mon State, Myanmar. Participants were randomly assigned to the order of clothing distribution and followed up at 2, 4 and 6 week intervals. Acceptability was assessed through structured questionnaires, focus group discussions and in-depth interviews. A cluster-level non-inferiority analysis was conducted using STATA, while qualitative data were digitally recorded, transcribed and content-analysed to identify patterns and themes, and managed thematically in Excel 2010®. Results Acceptability of both types of clothing was high. ITC was deduced to be non-inferior to NTC for seven out of eight indicators regarding perceptions (looks nice, is durable, is pleasant to wear for nighttime work, reduces mosquito bites, would recommend the clothing, would buy the clothing, like the clothing overall). A high proportion of respondents reported that the clothing reduced mosquito bites (ITC-98%; NTC-94%). Clothing was worn regularly (about 11 times in the previous two weeks). The most common reasons for not wearing the clothing every night were that it was being washed or dried, or the participant did not go to work. Conclusions The high level of acceptability suggests that ITC could be an appropriate strategy for personal protection amongst migrant rubber tappers in outdoor transmission settings in Myanmar. However, more research is needed into the feasibility and protective efficacy of ITC before it can be considered for wider roll-out. Trial registration Clinical trials ACTRN12615000432516
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Affiliation(s)
- Alison F Crawshaw
- Malaria Consortium Myanmar, 37/B Thiri Mingalar Street, Kamayut Township, Yangon, Myanmar.
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road, Dagon Township, Yangon, Myanmar
| | - Muhammad Shafique
- Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, Santasiri Sommani Building, 8th Floor, 420/6 Rajavidhi Road, Bangkok, 10400, Thailand
| | - Nyan Sint
- Vector Borne Diseases Control (National Malaria Control Programme), Mon State Public Health Department, Ministry of Health and Sports, Science School Street, Bo Gone Quarter, Mawlamyine, Mon State, Myanmar
| | | | - Michelle S Li
- Malaria Consortium, 56 Leonard Street, London, EC2A 4LT, UK
| | | | - Jeffrey Hii
- Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, Santasiri Sommani Building, 8th Floor, 420/6 Rajavidhi Road, Bangkok, 10400, Thailand
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Swana EK, Makan GY, Mukeng CK, Mupumba HI, Kalaba GM, Luboya ON, Bangs MJ. Feasibility and implementation of community-based malaria case management with integrated vector control in the Democratic Republic of Congo. Malar J 2016; 15:413. [PMID: 27527707 PMCID: PMC4986187 DOI: 10.1186/s12936-016-1475-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/04/2016] [Indexed: 12/22/2022] Open
Abstract
Background Malaria prevalence in the Mulumbu Health Area in Lualaba Province, Democratic Republic of the Congo has remained high (>70 %) despite repeated vector control (indoor residual spray) and mass insecticide-treated bed net coverage. Therefore, a pilot study was implemented to attack the parasite directly and demonstrate the feasibility and acceptability of community case management of malaria (CCMm) using trained community health workers (CHWs). Methods A 13 month prospective evaluation of CCMm was undertaken in 14 rural villages. Focus group discussions and structured interviews were conducted in pre- and post-intervention periods to assess community acceptability of CCMm. Weekly data collected by CHWs assessed program impact over time, matched with malaria school-based prevalence surveys (MSPS) in the Mulumbu Health Area (CCMm study arm) compared to a comparison (non-CCMm) arm in the Mpala Health Area approximately 25 km apart. Results Overall population perception of the CCMm was highly positive. 6619 community contacts were managed by CHWs from which 1433 (21.6 %) were malaria positive by rapid detection tests during the 10 month intervention. Among the malaria infected, 94.7 % (1358) were recorded as ‘uncomplicated’ infections with 99.7 % provided full course of treatment. CHWs referred 278 (4.2 %) patients deemed ‘complicated’ to a designated primary health center for advanced care. While pre-intervention MSPS data revealed significantly higher (p = 0.0135) malaria in the CCMm area compared to the non-CCMm area, at post-intervention there was no statistical difference (p = 0.562) between the two areas. Notably, for the first time, no malaria-related deaths were recorded in the 14 CCMm intervention villages during observation. Conclusion Community case management of malaria was shown to be an effective and promising strategy for prompt and effective management of malaria. It was well accepted by the community and showed evidence of a reduction in malaria morbidity and mortality. Further refinement of CCMm implementation, cost implications and sustainability is advised before expanding the programme.
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Affiliation(s)
- Edouard Kawawa Swana
- Freeport/International SOS Public Health Program, Tenke Fungurume Mining Project, Lualaba, Democratic Republic of the Congo. .,Faculty of Medicine and School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
| | - Ghislain Yav Makan
- Division Provinciale de la Santé Katanga, Lubumbashi, Democratic Republic of the Congo
| | - Clarence Kaut Mukeng
- Faculty of Medicine and School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Henriette Ilunga Mupumba
- Faculty of Social Sciences, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Gabriel Mutabusha Kalaba
- Faculty of Social Sciences, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Oscar Numbi Luboya
- Faculty of Medicine and School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Michael J Bangs
- Faculty of Medicine and School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.,Freeport/International SOS Public Health & Malaria Control, Papua, Kuala Kencana, 99920, Indonesia
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Ong KIC, Araki H, Kano S, Jimba M. The potential of positive deviance approach for the sustainable control of neglected tropical diseases. Trop Med Health 2016; 44:20. [PMID: 27436959 PMCID: PMC4944241 DOI: 10.1186/s41182-016-0023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022] Open
Abstract
Neglected tropical diseases (NTDs) have gained much attention in recent years due to the support from various agencies. However, the main approach to combat NTDs has been to cure rather than to prevent. As many NTD infections are closely linked with human behaviors such as hygienic practices and tradition, behavior change is also very crucial to prevent relapse or reinfection. Therefore, we would like to suggest a potential new approach—the positive deviance approach—to tackle NTDs by focusing on the preventive phase. What makes this approach unique is that the solution comes from the affected population themselves and not from the expert outsiders. Preventive chemotherapy that relies on outside aid has serious sustainability issues as reinfection is also high after the aid program has ended. Learning from the success story in Vietnam on preventing childhood malnutrition, the positive deviance approach could end the spread of NTDs once and for all by making full use of the available local solutions.
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Affiliation(s)
- Ken Ing Cherng Ong
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hitomi Araki
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeyuki Kano
- Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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