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Rotejanaprasert C, Malaphone V, Mayxay M, Chindavongsa K, Banouvong V, Khamlome B, Vilay P, Vanisavaeth V, Maude RJ. Malaria epidemiology, surveillance and response for elimination in Lao PDR. Infect Dis Poverty 2024; 13:35. [PMID: 38783374 PMCID: PMC11112833 DOI: 10.1186/s40249-024-01202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Lao PDR has made significant progress in malaria control. The National Strategic Plans outline ambitious targets, aiming for the elimination of Plasmodium falciparum and P. vivax malaria from all northern provinces by 2025 and national elimination by 2030. This article presents an overview of malaria epidemiology, surveillance, and response systems in Lao PDR, emphasizing experiences and achievements in transmission reduction. METHODS Data on surveillance, monitoring and evaluation systems, human resources, infrastructure, and community malaria knowledge during 2010-2020 were systematically gathered from the national program and relevant documents. The collected information was synthesized, and discussions on challenges and future prospects were provided. RESULTS Malaria control and elimination activities in Lao PDR were implemented at various levels, with a focus on health facility catchment areas. There has been significant progress in reducing malaria transmission throughout the country. Targeted interventions, such as case management, vector control, and community engagement, using stratification of control interventions by catchment areas have contributed to the decline in malaria cases. In elimination areas, active surveillance strategies, including case and foci investigation, are implemented to identify and stop transmission. The surveillance system has facilitated timely detection and response to malaria cases, enabling these targeted interventions in higher-risk areas. CONCLUSIONS The malaria surveillance and response system in Lao PDR has played a crucial role in reducing transmission and advancing the country towards elimination. Challenges such as importation, drug resistance, and sustaining support require ongoing efforts. Further strengthening surveillance, improving access to services, and addressing transmission determinants are key areas of focus to achieve malaria elimination and enhance population health in Lao PDR.
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Affiliation(s)
- Chawarat Rotejanaprasert
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Vilayvone Malaphone
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Virasack Banouvong
- Center of Malariology, Parasitology, and Entomology, Vientiane, Lao PDR, Laos
| | - Boualam Khamlome
- Center of Malariology, Parasitology, and Entomology, Vientiane, Lao PDR, Laos
| | - Phoutnalong Vilay
- Center of Malariology, Parasitology, and Entomology, Vientiane, Lao PDR, Laos
| | | | - Richard J 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
- The Open University, Milton Keynes, UK
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Audibert C, Aspinall A, Tchouatieu AM, Hugo P. Evaluation of Segmentation, Rotation, and Geographic Delivery Approaches for Deployment of Multiple First-Line Treatment (MFT) to Respond to Antimalarial Drug Resistance in Africa: A Qualitative Study in Seven Sub-Sahara Countries. Trop Med Infect Dis 2024; 9:93. [PMID: 38787026 PMCID: PMC11125622 DOI: 10.3390/tropicalmed9050093] [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: 03/18/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Several studies recently confirmed the emergence of resistance to antimalarial drugs in sub-Saharan Africa. Multiple first-line treatment (MFT) is one of the measures envisaged to respond to the emergence and spread of this resistance. The aim of this study was to identify the perceived advantages and disadvantages of several MFT deployment strategies and to better understand potential implementation drivers and barriers. METHODS A qualitative survey was conducted in seven sub-Saharan countries amongst key opinion leaders, national decision makers, and end users. A total of 200 individual interviews were conducted and findings were analyzed following a thematic inductive approach. RESULTS From a policy perspective, the new MFT intervention would require endorsement at the global, national, and regional levels to ensure its inclusion in guidelines. Funding of the MFT intervention could be a bottleneck due to costs associated with additional training of healthcare workers, adaptation of drug delivery mechanisms, and higher costs of drugs. Concerning the MFT deployment strategies, a slight preference for the segmentation strategy was expressed over the rotation and geographic approaches, due to the perception that a segmentation approach is already in place at country level. CONCLUSIONS The findings highlighted the need for a collective approach to MFT deployment through the engagement of stakeholders at all levels of malaria management.
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Affiliation(s)
- Celine Audibert
- Medicines for Malaria Venture (MMV), Route de Pre-Bois 20, 1215 Meyrin, Switzerland; (A.A.)
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Awasthi KR, Jancey J, Clements ACA, Rai R, Leavy JE. Community engagement approaches for malaria prevention, control and elimination: a scoping review. BMJ Open 2024; 14:e081982. [PMID: 38365295 PMCID: PMC10875526 DOI: 10.1136/bmjopen-2023-081982] [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] [Received: 11/11/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Globally malaria programmes have adopted approaches to community engagement (ACE) to design and deliver malaria interventions. This scoping review aimed to understand, map, and synthesise intervention activities guided by ACE and implemented by countries worldwide for the prevention, control and elimination of malaria. METHODS Three databases (Web of Science, Proquest, and Medline) were searched for peer-reviewed, primary studies, published in English between 1 January 2000 and 31 December 2022. Advanced Google was used to search for grey literature. The five levels of the International Association for Public Participation were used to categorise ACE - (1) Inform, (2) Consult, (3) involve, (4) Collaborate, and (5) Co-lead. Intervention activities were categorised as health education (HE), and/or health services (HS), and/or environmental management (EM). Outcomes were collected as knowledge, attitude, behaviour, help-seeking, health and HS and environment. Enablers and barriers were identified. Malaria intervention phases were categorised as (1) prevention (P), or (2) control (C), or (3) prevention and control (PC) or prevention, control and elimination (PCE). RESULTS Seventy-five studies were included in the review. Based on ACE levels, most studies were at the inform (n=37) and involve (n=26) level. HE (n=66) and HS (n=43) were the common intervention activities. HE informed communities about malaria, its prevention and vector control. EM activities were effective when complemented by HE. Community-based HS using locally recruited health workers was well-accepted by the community. Involvement of local leaders and collaboration with local stakeholders can be enablers for malaria intervention activities. CONCLUSION Involving local leaders and community groups in all stages of malaria prevention programmes is vital for successful interventions. Key elements of successful ACE, that is, consult, collaborate, and co-lead were under-represented in the literature and require attention. National programes must consult and collaborate with community stakeholders to develop ownership of the interventions and eventually co-lead them.
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Affiliation(s)
- Kiran Raj Awasthi
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jonine Jancey
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Rajni Rai
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Woldeghebriel M, Aso E, Berlin E, Fashanu C, Kirumira SN, Lam F, Mugerwa R, Nakiganda J, Olaleye T, Opigo J, Osinupebi F, Priestley N, Stringham R, Uhomoibhi P, Visser T, Ward A, Wiwa O, Woolsey A. Assessing availability, prices, and market share of quality-assured malaria ACT and RDT in the private retail sector in Nigeria and Uganda. Malar J 2024; 23:41. [PMID: 38321459 PMCID: PMC10848491 DOI: 10.1186/s12936-024-04863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND An estimated 50% of suspected malaria cases in sub-Saharan Africa first seek care in the private sector, especially in private medicine retail outlets. Quality of care in these outlets is generally unknown but considered poor with many patients not receiving a confirmatory diagnosis or the recommended first-line artemisinin-based combination therapy (ACT). In 2010, a subsidy pilot scheme, the Affordable Medicines Facility malaria, was introduced to crowd out the use of monotherapies in favour of WHO-pre-qualified artemisinin-based combinations (WHO-PQ-ACTs) in the private health sector. The scheme improved the availability, market share, and cost of WHO-PQ-ACTs in countries like Nigeria and Uganda, but in 2018, the subsidies were halted in Nigeria and significantly reduced in Uganda. This paper presents findings from six retail audit surveys conducted from 2014 to 2021 in Nigeria and Uganda to assess whether the impact of subsidies on the price, availability, and market share of artemisinin-based combinations has been sustained after the subsidies were reduced or discontinued. METHODS Six independent retail audits were conducted in private medicine retail outlets, including pharmacies, drug shops, and clinics in Nigeria (2016, 2018, 2021), and Uganda (2014, 2019, 2020) to assess the availability, price, and market share of anti-malarials, including WHO-PQ-ACTs and non-WHO-PQ-ACTs, and malaria rapid diagnostic tests (RDTs). RESULTS Between 2016 and 2021, there was a 57% decrease in WHO-PQ-ACT availability in Nigeria and a 9% decrease in Uganda. During the same period, non-WHO-PQ-ACT availability increased in Nigeria by 41% and by 34% in Uganda. The price of WHO-PQ-ACTs increased by 42% in Nigeria to $0.68 and increased in Uganda by 24% to $0.95. The price of non-WHO-PQ-ACTs decreased in Nigeria by 26% to $1.08 and decreased in Uganda by 64% to $1.23. There was a 76% decrease in the market share of WHO-PQ-ACTs in Nigeria and a 17% decrease in Uganda. Malaria RDT availability remained low throughout. CONCLUSION With the reduction or termination of subsidies for WHO-PQ-ACTs in Uganda and Nigeria, retail prices have increased, and retail prices of non-WHO-PQ-ACTs decreased, likely contributing to a shift of higher availability and increased use of non-WHO-PQ-ACTs.
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Affiliation(s)
| | - Ezinne Aso
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Erica Berlin
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | | | - Felix Lam
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Robert Mugerwa
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Tayo Olaleye
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | | | | | | | - Theodoor Visser
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Abigail Ward
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Aaron Woolsey
- Clinton Health Access Initiative, Boston, Massachusetts, USA
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Sharan M, Vijay D, Yadav JP, Bedi JS, Dhaka P. Surveillance and response strategies for zoonotic diseases: a comprehensive review. SCIENCE IN ONE HEALTH 2023; 2:100050. [PMID: 39077041 PMCID: PMC11262259 DOI: 10.1016/j.soh.2023.100050] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/29/2023] [Indexed: 07/31/2024]
Abstract
Out of all emerging infectious diseases, approximately 75% are of zoonotic origin, with their source often traced back to animals. The emergence of zoonoses is driven by a complex interplay between anthropogenic, genetic, ecological, socioeconomic, and climatic factors. This intricate web of influences poses significant challenges for the prediction and prevention of zoonotic outbreaks. Effective coordination and collaboration among the animal, human, and environmental health sectors are essential for proactively addressing major zoonotic diseases. Despite advancements in surveillance and diagnostic practices, the emergence of zoonoses continues to be a pressing global concern. Therefore, prioritizing zoonotic disease surveillance is of paramount importance as part of a comprehensive disease prevention and containment strategy. Furthermore, evaluating existing surveillance systems provides insights into the challenges faced, which can be mitigated through implementation of One Health principles involving relevant stakeholders. To initiate multisectoral partnerships, it is crucial to identify the priorities and core themes of surveillance systems with equitable inputs from various sectors. Strengthening surveillance, promoting data sharing, enhancing laboratory testing capabilities, and fostering joint outbreak responses in both the human and animal health sectors will establish the necessary infrastructure to effectively prevent, predict, detect, and respond to emerging health threats, thereby reinforcing global health security. This review assesses existing surveillance approaches by offering an overview of global agencies engaged in monitoring zoonoses and outlines the essential components required at the human-animal-environment interface for designing comprehensive surveillance networks. Additionally, it discusses the key steps necessary for executing effective zoonotic disease surveillance through a One Health approach, while highlighting the key challenges encountered in establishing such a robust surveillance system.
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Affiliation(s)
- Manjeet Sharan
- Animal and Fisheries Resources Department, Patna, Bihar, 800015, India
| | - Deepthi Vijay
- Department of Veterinary Public Health, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur, 680651, India
| | - Jay Prakash Yadav
- Department of Veterinary Public Health and Epidemiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Rampura Phul, Bathinda, 151103, India
| | - Jasbir Singh Bedi
- Centre for One Health, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, India
| | - Pankaj Dhaka
- Centre for One Health, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, India
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Osman A, Amoako Johnson F, Mariwah S, Amoako-Sakyi D, Asiedu Owusu S, Ekor M, Hamill H, Hampshire K. Antimalarial stocking decisions among medicine retailers in Ghana: implications for quality management and control of malaria. BMJ Glob Health 2023; 6:e013426. [PMID: 37734858 PMCID: PMC10846845 DOI: 10.1136/bmjgh-2023-013426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/12/2023] [Indexed: 09/23/2023] Open
Abstract
Global health efforts such as malarial control require efficient pharmaceutical supply chains to ensure effective delivery of quality-assured medicines to those who need them. However, very little is currently known about decision-making processes within antimalarial supply chains and potential vulnerabilities to substandard and falsified medicines. Addressing this gap, we report on a study that investigated decision-making around the stocking of antimalarial products among private-sector medicine retailers in Ghana. Licensed retail pharmacies and over-the-counter (OTC) medicine retail outlets were sampled across six regions of Ghana using a two-stage stratified sampling procedure, with antimalarial medicines categorised as 'expensive,' 'mid-range,' and 'cheaper,' relative to other products in the shop. Retailers were asked about their motivations for choosing to stock particular products over others. The reasons were grouped into three categories: financial, reputation/experience and professional recommendation. Reputation/experience (76%, 95% CI 72.0% to 80.7%) were the drivers of antimalarial stocking decisions, followed by financial reasons (53.2%, 95% CI 48.1% to 58.3%) and recommendation by certified health professionals (24.7%, 95% CI 20.3% to 29.1%). Financial considerations were particularly influential in stocking decisions of cheaper medicines. Moreover, pharmacies and OTCs without a qualified pharmacist were significantly more likely to indicate financial reasons as a motivation for stocking decisions. No significant differences in stocking decisions were found by geographical location (zone and urban/rural) or outlet (pharmacy/OTC). These findings have implications for the management of antimalarial quality across supply chains in Ghana, with potentially important consequences for malaria control, particularly in lower-income areas where people rely on low-cost medication.
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Affiliation(s)
- Adams Osman
- Department of Geography Education, University of Education, Winneba, Ghana
| | - Fiifi Amoako Johnson
- Department of Population and Health, University of Cape Coast Faculty of Social Sciences, Cape Coast, Ghana
| | - Simon Mariwah
- Department of Geography and Regional Planning, University of Cape Coast Faculty of Social Sciences, Cape Coast, Ghana
| | | | - Samuel Asiedu Owusu
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Martins Ekor
- School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Kate Hampshire
- Department of Anthropology, Durham University, Durham, UK
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Ali D, Woldegiorgis AGY, Tilaye M, Yilma Y, Berhane HY, Tewahido D, Abelti G, Neill R, Silla N, Gilliss L, Mandal M. Integrating private health facilities in government-led health systems: a case study of the public-private mix approach in Ethiopia. BMC Health Serv Res 2022; 22:1477. [PMID: 36463163 PMCID: PMC9719643 DOI: 10.1186/s12913-022-08769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Private health care facilities working in partnership with the public health sector is one option to create sustainable health systems and ensure health and well-being for all in low-income countries. As the second-most populous country in Africa with a rapidly growing economy, demand for health services in Ethiopia is increasing and one-quarter of its health facilities are privately owned. The Private Health Sector Program (PHSP), funded by the United States Agency for International Development, implemented a series of public-private partnership in health projects from 2004 to 2020 to address several public health priorities, including tuberculosis, malaria, HIV/AIDS, and family planning. We assessed PHSP's performance in leadership and governance, access to medicines, health management information systems, human resources, service provision, and finance. METHODS The World Health Organization's health systems strengthening framework, which is organized around six health system building blocks, guided the assessment. We conducted 50 key informant interviews and a health facility assessment at 106 private health facilities supported by the PHSP to evaluate its performance. RESULTS All six building blocks were addressed by the program and key informants shared that several policy and strategic changes were conducive to supporting the functioning of private health facilities. The provision of free medicines from the public pharmaceutical logistics system, relaxation of strict regulatory policies that restricted service provision through the private sector, training of private providers, and public-private mix guidelines developed for tuberculosis, malaria, and reproductive, maternal, newborn, child, and adolescent health helped increase the use of services at health facilities. CONCLUSIONS Some challenges and threats to sustainability remain, including fragile partnerships between public and private bodies, resource constraints, mistrust between the public and private sectors, limited incentives for the private sector, and oversight of the quality of services. To continue with gains in the policy environment, service accessibility, and other aspects of the health system, the government and international communities must work collaboratively to address public-private partnerships in health areas that can be strengthened. Future efforts should emphasize a mechanism to ensure that the private sector is capable, incentivized, and supervised to deliver continuous, high-quality and equitable services.
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Affiliation(s)
- Disha Ali
- John Snow, Inc. (JSI), Arlington, VA, USA
| | | | - Mesfin Tilaye
- USAID/Ethiopia, Entoto Street, Addis Ababa, Ethiopia
| | - Yonas Yilma
- Independent Consultant, Addis Ababa, Ethiopia
| | - Hanna Y Berhane
- Addis Continental Institute of Public Health, Ayat, Addis Ababa, Ethiopia
| | - Dagmawit Tewahido
- Addis Continental Institute of Public Health, Ayat, Addis Ababa, Ethiopia
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Argaw MD, Mavundla TR, Gidebo KD, Desta BF, Damte HD, Mebratu W, Edossa W, Dillu D, Mitiku AD, Desale AY. Adherence of healthcare providers to malaria case management guidelines of the formal private sector in north-western Ethiopia: an implication for malaria control and elimination. Malar J 2022; 21:347. [PMID: 36414935 PMCID: PMC9682744 DOI: 10.1186/s12936-022-04379-0] [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: 03/12/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Malaria is an infectious disease which has been globally targeted for elimination in at least 35 of 90 endemic countries by 2030. Most successful malaria elimination country programmes have engaged the private health sector in an effort to identify, document, investigate, provide effective treatment, and follow-up cases. However, there has been limited rigorous research showing evidence of adherence among healthcare providers of the formal private health sector to national malaria diagnosis and treatment guidelines in Ethiopia, starting from malaria control to elimination phases. The aims of this study were to investigate and explain the level of adherence to malaria diagnosis and treatment guidelines among healthcare providers working in formal private health facilities in north-western Ethiopia. METHODS An explanatory sequential mixed method design was conducted in the West Gojjam Zone of Ethiopia. Quantitative data were extracted from 1650 medical records of adult uncomplicated malaria outpatients served in 11 private-for-profit health facilities. In addition, using a qualitative approach, 33 in-depth interviews (IDIs) with healthcare providers were conducted. All interviews were audio-recorded, transcribed verbatim, and analysed using eight steps. RESULTS Of 1650 suspected malaria cases in adult outpatients, 80.6% (1330/1650) were screen tested using microscopy and the remainder 19.4% (320/1650) were tested using multispecies rapid diagnosis tests (RDTs). Hence, the results revealed that private healthcare providers universally adhered to diagnosis guidelines. In addition, after following-up and excluding other causes of fever, 4.1% (56/1376) patients were clinically diagnosed with uncomplicated malaria. Despite this, the proportion of private healthcare provider adherence with confirmed malaria case treatment guidelines was 20.9% (69/330). In addition, 1320 (95.9%) of adult outpatients with negative laboratory results were not treated. Some of the identified determinant factors for sub-optimal adherence of healthcare providers to malaria guidelines were interruptions in supply and lack of availability of recommended anti-malarial drugs, lack of availability of quality assured laboratory supplies, and poor knowledge of the recommendations of the national standards. CONCLUSIONS Private healthcare providers adhered to universal parasitological diagnosis, providing comprehensive counseling, and linking patients with community health workers. In addition, almost all laboratory negative patients were not treated with anti-malarial drugs. However, only one-fifth of confirmed patients were treated in line with national guideline recommendations. Malaria control and elimination efforts across Ethiopia could be improved through establishing a collaborative function of a win-win public private mix partnership model. In addition, including the data of the private health sector in the health information system could show real malaria burden and use the information to improve the adherence to malaria diagnosis, treatment, and reporting standards within the targeted era of elimination. Therefore, building the capacity of private healthcare providers and ensuring the availability of all nationally recommended drugs and supplies in private health sector facilities is recommended to improve the quality of services.
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Affiliation(s)
- Mesele Damte Argaw
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc., in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia.
- Department of Health Studies, University of South Africa (UNISA), Pretoria, South Africa.
| | - Thandisizwe Redford Mavundla
- Department of Nursing Education, University of Witwatersrand, Johannesburg, South Africa
- Department of Health Studies, University of South Africa (UNISA), Pretoria, South Africa
| | - Kassa Daka Gidebo
- School of Public Health, Wolaita Sodo University, College of Health Sciences and Medicine, Wolaita Sodo, Ethiopia
| | - Binyam Fekadu Desta
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc., in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
- Department of Health Studies, University of South Africa (UNISA), Pretoria, South Africa
| | - Heran Demissie Damte
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc., in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
| | - Wondwosen Mebratu
- School of Public Health, Wollo University, College of Health Sciences and Medicine, Dessie, Ethiopia
| | - Wasihun Edossa
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Dereje Dillu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Aychiluhim Damtew Mitiku
- USAID Transform: Primary Health Care Activity, JSI Research & Training Institute, Inc., in Ethiopia, P.O. Box 1392 code 1110, Addis Ababa, Ethiopia
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Carlton JM, Sahu PK, Wassmer SC, Mohanty S, Kessler A, Eapen A, Tomko SS, Walton C, Joshi PL, Das D, Albert S, Peter BK, Pradhan MM, Dash AP, Das A. The Impact, Emerging Needs, and New Research Questions Arising from 12 Years of the Center for the Study of Complex Malaria in India. Am J Trop Med Hyg 2022; 107:90-96. [PMID: 36228922 PMCID: PMC9662226 DOI: 10.4269/ajtmh.21-1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/28/2022] [Indexed: 11/24/2022] Open
Abstract
The Center for the Study of Complex Malaria in India (CSCMi) was launched in 2010 with the overall goal of addressing major gaps in our understanding of "complex malaria" in India through projects on the epidemiology, transmission, and pathogenesis of the disease. The Center was mandated to adopt an integrated approach to malaria research, including building capacity, developing infrastructure, and nurturing future malaria leaders while conducting relevant and impactful studies to assist India as it moves from control to elimination. Here, we will outline some of the interactions and impacts the Center has had with malaria policy and control counterparts in India, as well as describe emerging needs and new research questions that have become apparent over the past 12 years.
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Affiliation(s)
- Jane M. Carlton
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, New York
- Department of Epidemiology, School of Global Public Health, New York University, New York, New York
- Address correspondence to Jane M. Carlton, Center for Genomics and Systems Biology, New York University, 12 Waverly Place, New York, NY 10003. E-mail:
| | - Praveen K. Sahu
- Department of Molecular and Infectious Diseases, Community Welfare Society Hospital, Rourkela, India
| | - Samuel C. Wassmer
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sanjib Mohanty
- Department of Molecular and Infectious Diseases, Community Welfare Society Hospital, Rourkela, India
| | - Anne Kessler
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, New York
| | - Alex Eapen
- IDVC Field Unit, National Institute of Malaria Research, Indian Council of Medical Research, National Institute of Epidemiology Campus, Chennai, India
| | - Sheena Shah Tomko
- Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Walton
- Department of Earth and Environmental Sciences, School of Natural Sciences, University of Manchester, Manchester, United Kingdom
| | - Pyare L. Joshi
- Joint Scientific Advisory Committee, Indian Council of Medical Research, and Malaria No More, India Programme, New Delhi, India
| | - Deben Das
- District Headquarters Hospital, Keonjhar, India
| | - Sandra Albert
- Indian Institute of Public Health—Shillong, Shillong, India
- Martin Luther Christian University, Shillong, India
| | | | - Madan M. Pradhan
- Department of Health and Family Welfare, State Vector Borne Disease Control Programme, Bhubaneswar, India
| | - Aditya P. Dash
- Asian Institute of Public Health University, Bhubaneswar, India
| | - Aparup Das
- National Institute of Research in Tribal Health, Indian Council of Medical Research, Jabalpur, India
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Kabwama SN, Kiwanuka SN, Mapatano MA, Fawole OI, Seck I, Namale A, Ndejjo R, Kizito S, Monje F, Bosonkie M, Egbende L, Bello S, Bamgboye EA, Dairo MD, Adebowale AS, Salawu MM, Afolabi RF, Diallo I, Leye MMM, Ndiaye Y, Fall M, Bassoum O, Alfvén T, Sambisa W, Wanyenze RK. Private sector engagement in the COVID-19 response: experiences and lessons from the Democratic Republic of Congo, Nigeria, Senegal and Uganda. Global Health 2022; 18:60. [PMID: 35705961 PMCID: PMC9199342 DOI: 10.1186/s12992-022-00853-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Private entities play a major role in health globally. However, their contribution has not been fully optimized to strengthen delivery of public health services. The COVID-19 pandemic has overwhelmed health systems and precipitated coalitions between public and private sectors to address critical gaps in the response. We conducted a study to document the public and private sector partnerships and engagements to inform current and future responses to public health emergencies. METHODS This was a multi-country cross-sectional study conducted in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 to assess responses to the COVID-19 pandemic. We conducted a scoping literature review and key informant interviews (KIIs) with private and public health sector stakeholders. The literature reviewed included COVID-19 country guidelines and response plans, program reports and peer-reviewed and non-peer-reviewed publications. KIIs elicited information on country approaches and response strategies specifically the engagement of the private sector in any of the strategic response operations. RESULTS Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. In the DRC and Nigeria, private entities supported contact tracing and surveillance activities. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. The private sector also contributed to treatment and management of COVID-19 cases. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in the provision of services. CONCLUSIONS The private sector contributed to the COVID-19 response through engagement in COVID-19 surveillance and testing, management of COVID-19 cases, and health promotion to maintain health access. There is a need to develop regulatory frameworks for sustainable public-private engagements including regulation of pricing, quality assurance and alignment with national plans and priorities during response to epidemics.
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Affiliation(s)
- Steven N Kabwama
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda. .,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Suzanne N Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Mala Ali Mapatano
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Ibrahima Seck
- Department of Preventive Medicine and Public Health, University Cheikh Antar Diop, Dakar, Senegal
| | - Alice Namale
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Susan Kizito
- Makerere University School of Public Health, Kampala, Uganda
| | - Fred Monje
- Makerere University School of Public Health, Kampala, Uganda
| | - Marc Bosonkie
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Landry Egbende
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Segun Bello
- Faculty of Public Health, College of Medicine, University of Ibadan, Oyo, Nigeria
| | - Eniola A Bamgboye
- Faculty of Public Health, College of Medicine, University of Ibadan, Oyo, Nigeria
| | - Magbagbeola D Dairo
- Faculty of Public Health, College of Medicine, University of Ibadan, Oyo, Nigeria
| | - Ayo S Adebowale
- Faculty of Public Health, College of Medicine, University of Ibadan, Oyo, Nigeria
| | - Mobolaji M Salawu
- Faculty of Public Health, College of Medicine, University of Ibadan, Oyo, Nigeria
| | - Rotimi F Afolabi
- Faculty of Public Health, College of Medicine, University of Ibadan, Oyo, Nigeria
| | - Issakha Diallo
- Department of Preventive Medicine and Public Health, University Cheikh Antar Diop, Dakar, Senegal
| | - Mamadou M M Leye
- Department of Preventive Medicine and Public Health, University Cheikh Antar Diop, Dakar, Senegal
| | - Youssou Ndiaye
- Department of Preventive Medicine and Public Health, University Cheikh Antar Diop, Dakar, Senegal
| | - Mane Fall
- Department of Preventive Medicine and Public Health, University Cheikh Antar Diop, Dakar, Senegal
| | - Oumar Bassoum
- Department of Preventive Medicine and Public Health, University Cheikh Antar Diop, Dakar, Senegal
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Aung YK, Zin SS, Tesfazghi K, Paudel M, Thet MM, Thein ST. A comparison of malaria prevention behaviours, care-seeking practices and barriers between malaria at-risk worksite migrant workers and villagers in Northern Shan State, Myanmar-a mixed method study. Malar J 2022; 21:162. [PMID: 35658947 PMCID: PMC9166652 DOI: 10.1186/s12936-022-04193-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Migrant populations are at an increased risk of exposure to malaria due to their nature of work and seasonal migration. This study aimed to compare malaria prevention behaviours and care-seeking practices among worksite migrant workers and villagers in the malaria-at-risk areas of Eastern Myanmar close to the China border. Methods A mixed method study was conducted in March 2019. The malaria-at-risk worksites in the four targeted townships, and villages located the nearest to these worksites were approached. Key stakeholders, such as worksite managers and village leaders, were interviewed. Results A total of 23 worksites, which employed 880 migrants and 447 locals, and 20 villages, which were homes for 621 migrants and 9731 locals, were successfully interviewed. Regarding malaria prevention behaviours, sleeping under a bed net was common among both worksites (74%) and villages (85%). In contrast, insecticide-treated nets/long-lasting insecticidal nets (ITN/LLIN) usage was much lower in the worksites than in the villages (39% vs 80%). Regarding care-seeking practices for febrile illness, self-medication was a popular choice for both worksite workers and villagers owing to the easy availability of western medicine. Moreover, local-belief-driven traditional practices were more common among villagers. For occasions in which fever was not relieved, both would seek health care from rural health centres, private clinics, or public hospitals. As for barriers, villagers mostly cited language barriers, which often lead to misunderstanding between health providers and them. In contrast, most of the worksites cited logistics issues as they were in remote areas with devastated road conditions and the routes to formal health facilities were not secure due to frequent armed conflicts. Conclusion This study demonstrated that site-workers and villagers had different malaria prevention behaviours and care-seeking practices even though they resided in the same geographic area. Hence, it is important to recognize such differences for more effective intervention approaches.
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Affiliation(s)
- Ye Kyaw Aung
- Strategic Information Department, Population Services International, 16, West Shwe Gone Dine 4th Street, Bahan Township, Yangon, Myanmar.
| | - Su Su Zin
- Strategic Information Department, Population Services International, 16, West Shwe Gone Dine 4th Street, Bahan Township, Yangon, Myanmar
| | | | - Mahesh Paudel
- Population Services International, Washington, DC, USA
| | - May Me Thet
- Strategic Information Department, Population Services International, 16, West Shwe Gone Dine 4th Street, Bahan Township, Yangon, Myanmar
| | - Si Thu Thein
- Strategic Information Department, Population Services International, 16, West Shwe Gone Dine 4th Street, Bahan Township, Yangon, Myanmar
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Furtado KM, Kar A. Private Sector Engagement for Infectious Disease Surveillance in Mixed Health Systems: Lessons from a Model Dengue Reporting Network in India. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221091011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disease estimates from surveillance in mixed health systems is affected by lack of data from the private sector. We aimed to characterize private sector engagement and reporting to a disease surveillance network, and determine the implications on dengue case detection. We developed and set up a public–private network (CODREN—Community Disease Detection and Response Network) with recruitment of eligible health resources ( n = 462) in a municipal ward of Pune city, India (population 209,331). Dengue cases reported through CODREN were compared with reports of the local dengue surveillance (LDS) over 1 year. Private clinics constituted the majority of eligible providers (60%, 276). Retention of participants was 81.7% with 13.9% reporting dengue cases. Phone call was the preferred reporting method (85.5%, 564 reports). CODREN captured a higher number of cases than LDS (78.9%, 251 vs 50.6%, 161), increasing case detection by 18% due to increased private reporting points. A twofold lower number of cases was reported by LDS from shared reporting points with CODREN, due to discrepancies in case definitions and diagnostic test preferences among private providers. We conclude that private sector engagement can improve dengue case detection with the selective inclusion of providers, sustained contact, feedback and simple reporting methods. Testing guidelines and case definitions adopted by the LDS need to address heterogeneity of private practice in mixed health systems, in order to improve dengue estimates in India.
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Affiliation(s)
- Kheya Melo Furtado
- Goa Institute of Management, Sanquelim, Goa, India
- School of Health Sciences-Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
| | - Anita Kar
- School of Health Sciences-Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
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Awasthi KR, Jancey J, Clements ACA, Leavy JE. A qualitative study of knowledge, attitudes and perceptions towards malaria prevention among people living in rural upper river valleys of Nepal. PLoS One 2022; 17:e0265561. [PMID: 35303022 PMCID: PMC8932613 DOI: 10.1371/journal.pone.0265561] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nepal has made significant progress in decreasing the number of malaria cases over the last two decades. Prevention and timely management of malaria are critical for the National Malaria Program in its quest for elimination. The study aimed to explore the knowledge, attitudes and behaviour towards malaria prevention and treatment among people living in rural villages of Khatyad Rural Municipality in Nepal. METHODS This qualitative study collected information through virtual in-depth interviews (N = 25) with female and male participants aged between 15 and 72 years. RESULTS More than half of the participants knew about the causes of malaria, were aware of the complications of untreated malaria and knew that anti-malarial medicines were provided for free at the public health facilities. Participants indicated that their first choice of health care were public health facilities, however limited supply of medications and diagnostics deviated patients to the private sector. While tertiary care costs were not financially viable, participants opted against traditional care for malaria. Factors such as cost of treatment, distance to the health facility and the decision making authority in households influenced health related decisions in the family. Although long-lasting insecticidal nets were distributed and indoor residual spraying was done periodically, several barriers were identified. CONCLUSION Increased awareness of malaria prevention and treatment among people living in malaria risk areas is important for the National Malaria Program in its quest for malaria elimination in Nepal.
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Affiliation(s)
- Kiran Raj Awasthi
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | | | - Justine E. Leavy
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
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14
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Brown M, Bouanchaud P, Tesfazghi K, Phanalasy S, Thet MM, Nguyen H, Wheeler J. Motivation to test, treat, and report malaria cases: a quantitative assessment among private sector providers in the Greater Mekong Subregion. Malar J 2022; 21:82. [PMID: 35264168 PMCID: PMC8905864 DOI: 10.1186/s12936-022-04108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background Accurately testing, treating, and tracking all malaria cases is critical to achieving elimination. Ensuring health providers are able and motivated to test, treat, and report cases is a necessary component of elimination programmes, and particularly challenging in low endemic settings where providers may not encounter a large volume of cases. This study aimed to understand provider motivations to test, treat, and report malaria cases to better optimize programme design, adjust incentive schemes, and ultimately improve reporting rates while growing the evidence base around private providers in the Greater Mekong Subregion (GMS). Methods With funding from the Bill & Melinda Gates Foundation, this study aimed to identify and validate distinctive subtypes of motivation among private sector providers enrolled in the Greater Mekong Subregion Elimination of Malaria through Surveillance (GEMS) programme, implemented by Population Services International. Quantitative questionnaires were administered electronically in person by trained enumerators to various provider groups in Myanmar, Lao PDR, and Vietnam. A three-stage confirmatory factor analysis was then conducted in STATA. Results Following this analysis, a two-factor solution that describes motivation in this population of providers was identified, and providers were scored on the two dimensions of motivation. The correlation between the two rotated factors was 0.3889, and the Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was 0.93, indicating an excellent level of suitability. These providers, who are often assumed to only be financially motivated, engaged in malaria elimination activities because of both internal and external motivational factors that are independent of remuneration or financial gain. For all three countries’ data, significant covariances between the two latent variables for internal and external motivation were found. The models were found to be of adequate to good fit for the data across all three countries. It was determined that private sector providers, who were previously believed to be primarily financially motivated, were also motivated by personal factors. Motivation was also associated with key outcomes of importance to malaria elimination, such as reporting and stocking of tests and treatments. Conclusion Maintaining or increasing provider motivation to test and treat is essential in the fight to eliminate malaria from the GMS, as it helps to ensure that providers continue to pursue this goal, even in a low incidence environment where cases may be rare and in which providers face financial pressure to focus on areas of health service provision. Establishing mechanisms to better motivate providers through intrinsic factors is likely to have a substantive impact on the sustainability of malaria case management activities.
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Affiliation(s)
| | - Paul Bouanchaud
- Population Services International, 1120 19th St NW, Suite 600, Washington, DC, 20036, USA
| | - Kemi Tesfazghi
- Population Services International, 1120 19th St NW, Suite 600, Washington, DC, 20036, USA.
| | - Saysana Phanalasy
- Population Services International Laos, T4 Road, Unit 16, Donkoi Village, Sisattanak District, Vientiane Capital, Lao People's Democratic Republic
| | - May Me Thet
- Population Services International Myanmar, No.16 Shwe Gon Taing Street 4, Yangon, Myanmar
| | - Hoa Nguyen
- Population Services International Vietnam, VinaFor Building, 127 Lò Đúc, Phạm Đình Hổ, Hai Bà Trưng, Hanoi, Vietnam
| | - Jennifer Wheeler
- Population Services International, 1120 19th St NW, Suite 600, Washington, DC, 20036, USA
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15
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Edwards HM, Sarwar R, Mahmud P, Emmanuel S, Maxwell K, Tibenderana JK. The impact of the private sector co-payment mechanism (PSCM) on the private market for ACT in Nigeria: results of the 2018 cross-sectional outlet and household market surveys. Malar J 2022; 21:42. [PMID: 35151332 PMCID: PMC8841089 DOI: 10.1186/s12936-021-04039-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022] Open
Abstract
Background The private sector plays a large role in malaria treatment provision in Nigeria. To improve access to, and affordability of, quality-assured artemisinin-based combination therapy (QA-ACT) within this sector, the Affordable Medicines Facility-Malaria began operations in 2010 and transitioned to a private sector co-payment mechanism (PSCM) until 2017. To assess the impact of the scheme on the ACT market, cross-sectional household and outlet surveys were conducted in 2018 to coincide with the final stockages of ACT medicines procured under the PSCM. Methods An outlet survey was conducted targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability and cost of anti-malarials, including artemisinin-based combinations subsidised under the PSCM (called green leaf ACT on account of their green leaf logo) and those not subsidised (non-green leaf ACT). A concurrent household survey was conducted to determine demand-side factors related to treatment-seeking practices, ACT brand preference and purchase decision. Data were compared with previous ACTWatch surveys to consider change over time. Results Availability of artemisinin-based combinations increased significantly over the PSCM period and was almost universal by the time of the 2018 market survey. This increase was seen particularly among PPMVs. While the cost of green leaf ACT remained relatively stable over time, the cost of non-green leaf ACT reduced significantly so that by 2018 they had equivalent affordability. Unsubsidised brands were also available in different formulations and dosages, with double-strength artemisinin-based combination reported as the most frequently purchased dosage type, and child artemisinin-based combinations popular in suspension and dispersible forms (forms not subsidised by the PSCM). Conclusions The PSCM had a clear impact on increasing not only the reach of subsidized QA brands, but also of non-subsidised brands. Increased market competition led to innovation from unsubsidised brands and large reductions in costs to make them competitive with subsidised brands. Concerns are drawn from the large market share that non-QA brands have managed to gain as well as the continued market share of oral artemisinin monotherapies. Continued monitoring of the market is recommended, along with improved local capacity for QA-certification and monitoring. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-04039-9.
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Tumuhimbise W, Musiimenta A. Barriers and Motivators of private hospitals' engagement in Tuberculosis care in Uganda. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2021; 1:279-290. [PMID: 34927083 PMCID: PMC8682303 DOI: 10.1007/s43477-021-00030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The involvement of private hospitals in Tuberculosis care in Uganda is still limited. There is a lack of literature about the barriers and motivators to private hospitals' engagement in Tuberculosis care in Uganda. OBJECTIVE To explore the barriers to and motivators of private hospitals' engagement in Tuberculosis care. METHODS The study employed a qualitative study design that utilized in-depth interviews with 13 private healthcare workers purposively selected in June 2020 due to their active involvement in Tuberculosis care from four urban private hospitals in Mbarara Municipality. An inductive, content analytic approach framed by the Consolidated Framework for Implementation Research, was used for analysis. The interviews were transcribed and coded to identify key themes using content analysis. RESULTS Focusing through the Consolidated Framework for Implementation Research, barriers to private hospitals' engagement were related to cost, external policies and incentives, structure characteristics, networks and communications, and knowledge and beliefs about the intervention. These include concerns regarding the payment of care by patients; indirect income-generating nature of Tuberculosis management; lack of drugs, registers, and diagnostic tools; lack of accreditation from the Ugandan Ministry of Health; limited space for keeping Tuberculosis patients; lack of proper follow-up mechanism; lack of training and qualified human resources; and delayed seeking of health care by the patients. Perceived high quality of care in the private hospitals; privacy and confidentiality concerns; proximity of private hospitals to patients; and formalization of partnerships between private hospitals and the government were the motivators that arose from the three constructs (relative advantage, patient needs, and resources, and engaging). CONCLUSION The engagement of private hospitals in Tuberculosis care requires commitment from key stakeholders supplemented with the organizational shared beliefs towards this change. There is a need for ensuring mechanisms for lessening these barriers to ensure full engagement of private hospitals in Tuberculosis care.
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Affiliation(s)
| | - Angella Musiimenta
- Mbarara University of Science and Technology, Mbarara, Uganda
- Angels Compassion Organisation (ACO), Mbarara, Uganda
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Masunaga Y, Muela Ribera J, Nguyen TT, Tesfazghi K, Peeters Grietens K. In search of the last malaria cases: ethnographic methods for community and private-sector engagement in malaria elimination in Vietnam, Laos, and Cambodia. Malar J 2021; 20:370. [PMID: 34535133 PMCID: PMC8447739 DOI: 10.1186/s12936-021-03903-y] [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: 03/28/2021] [Accepted: 09/02/2021] [Indexed: 08/21/2023] Open
Abstract
Background Despite significant strides made in reducing malaria morbidity and mortality in the Greater Mekong Subregion, malaria transmission continues amongst the most ‘hard-to-reach’, such as forest-goers and mobile and migrant populations, who face access obstacles to malaria diagnosis and treatment. As such, regional malaria elimination strategies endeavour to incorporate the private sector and local communities in improving surveillance and detection of the last malaria cases in remote forested areas. The question remains, however, whether such strategies can reach these hard-to-reach populations and effectively reduce their disproportionate burden of malaria. This paper evaluates the strategy of community and private sector engagement in a malaria elimination project in Vietnam, Laos, and Cambodia. Methods Ethnographic research, incorporating in-depth interviews, participant observations with informal discussions, and group discussions were conducted in Bu Gia Map commune, Binh Phuc province of Vietnam; in Phouvong district, Attapeu province of Laos; and, in nine newly established and informal communities in the provinces of Mondul Kiri, Steung Treng, Kratie, Kampong Thom, and Prah Vihear of Cambodia. Results Different types of factors limited or enhanced the effectiveness of the participatory approaches in the different settings. In Vietnam, inter-ethnic tensions and sensitivity around forest-work negatively affected local population’s health-seeking behaviour and consequent uptake of malaria testing and treatment. In Laos, the location of the project collaborative pharmacies in the district-centre were a mismatch for reaching hard-to-reach populations in remote villages. In Cambodia, the strategy of recruiting community malaria-workers, elected by the community members, did manage to reach the remote forested areas where people visited or stayed. Conclusions ‘Hard-to-reach’ populations remain hard to reach without proper research identifying the socio-economic-political environment and the key dynamics determining uptake in involved communities and populations. Solid implementation research with a strong ethnographic component is required to tailor malaria elimination strategies to local contexts.
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Affiliation(s)
- Yoriko Masunaga
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. .,Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Joan Muela Ribera
- PASS Suisse, Neuchâtel, Switzerland.,Universitat Rovira i Virgili, Tarragona, Spain
| | - Thuan Thi Nguyen
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands.,National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | | | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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18
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Azzopardi PS, Hennegan J, Prabhu SM, Dagva B, Balibago MM, Htin PPW, Swe ZY, Kennedy EC. Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100242. [PMID: 34528016 PMCID: PMC8357832 DOI: 10.1016/j.lanwpc.2021.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/04/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
Background Public health services can be inaccessible for adolescents. The private sector provides many services, but often in parallel to the public sector. This study aimed to understand current private sector engagement in adolescent health service delivery and develop recommendations to strengthen partnerships. Methods The study focussed on Mongolia, Myanmar and the Philippines. An initial participatory workshop in each country was followed by semi-structured key-informant interviews (32 in total) with public and private sector actors and adolescents to explore: perceptions of the public and private sectors, strengths and challenges, existing models of partnership, and insights for successful public-private partnership (PPP). Interview transcripts were analysed thematically, with findings and recommendations verified through a second workshop in Mongolia and the Philippines. Findings The private sector already plays a significant role in adolescent health care, and stakeholders reported a genuine willingness for partnership. Strengthened PPP was identified as necessary to improve service accessibility and quality for adolescents, unburden the public sector and introduce new technologies, with advantages for the private sector including improved access to training and resources, and an enhanced public image. Recommendations for strengthened PPP included the need to establish the foundations for partnership, clearly define roles and co-ordinate stakeholders, ensure capacity and sustainability, and monitor and evaluate efforts. Interpretation This is the first comprehensive study of public-private partnership for adolescent health in the Asia Pacific region. It identifies stakeholders are willing for stronger partnerships and the benefits this partnership will bring. We define eight key recommendations to enable this partnership across sectors.
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Affiliation(s)
- Peter S Azzopardi
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Adolescent health and wellbeing program, Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Department of Paediatrics, School of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne Australia
| | - Julie Hennegan
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne
| | - Shirley Mark Prabhu
- Adolescent Health, Mental Health and HIV Specialist, UNICEF Middle East and North Africa Regional Office, Amman, Jordan (formerly UNICEF East Asia and Pacific Regional Office)
| | | | - Mx Mar Balibago
- Adolescent health and HIV/AIDS Specialist, UNICEF Philippines
| | | | - Zay Yar Swe
- Myanmar country program, International Development Discipline, Burnet Institute, Yangon, Myanmar
| | - Elissa C Kennedy
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Kaur J, Kaura T, Sharma A, Kumar A, Pangotra MK, Upadhyay AK, Anvikar A, Grover GS, Chaturvedi HK, Sharma SK. Surveillance-based estimation of the malaria disease burden in a low endemic state of Punjab, India, targeted for malaria elimination. Trans R Soc Trop Med Hyg 2021; 115:512-519. [PMID: 33539517 DOI: 10.1093/trstmh/trab005] [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: 09/28/2020] [Revised: 11/10/2020] [Accepted: 01/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The state of Punjab in India qualifies for malaria elimination because the number of cases reported through routine surveillance is in decline. However, surveillance system prevalence mainly provides malaria trends. Therefore, a prospective epidemiological study was designed to estimate the malaria burden in the state. METHODS District-wise annual parasite incidence (API) was used for identification of three strata, representing high, moderate and low API zones. A total of 0.9 million people from nine districts was under malaria surveillance for 1 y. The weighted estimates of API for the three regions was calculated and combined to give an estimate of API for the total population of the state. RESULTS Based upon the primary data generated, malaria cases from high, moderate and low malaria-endemic areas were estimated to be 3727, 904 and 106, respectively. Further, the total number of malaria cases in the state was estimated to be 4737 (95% CI 4006 to 5469) cases per annum. CONCLUSION Actual burden of malaria in the state of Punjab, India, is about seven to eight times higher than that reported by routine surveillance activities. However, the state still qualifies for malaria elimination but needs vigorous efforts to strengthen the active surveillance and reporting system along with implementation of effective control strategies to achieve malaria elimination.
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Affiliation(s)
- Jaspreet Kaur
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - Taruna Kaura
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - Ayush Sharma
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - Ashish Kumar
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - M K Pangotra
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - A K Upadhyay
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - Anupkumar Anvikar
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
| | - Gagandeep S Grover
- Directorate of Health Services, Government of Punjab, Parivar Kalyan Bhavan, Sector-34, Chandigarh, India
| | - H K Chaturvedi
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi, India
| | - Surya K Sharma
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
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Levin A, Potter R, Tesfazghi K, Phanalangsy S, Keo P, Filip E, Phone SH, Eliades MJ. Costing electronic private sector malaria surveillance in the Greater Mekong Subregion. Malar J 2021; 20:192. [PMID: 33879159 PMCID: PMC8056544 DOI: 10.1186/s12936-021-03727-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/07/2021] [Indexed: 11/14/2022] Open
Abstract
Background Private sector malaria programmes contribute to government-led malaria elimination strategies in Cambodia, Lao PDR, and Myanmar by increasing access to quality malaria services and surveillance data. However, reporting from private sector providers remains suboptimal in many settings. To support surveillance strengthening for elimination, a key programme strategy is to introduce electronic surveillance tools and systems to integrate private sector data with national systems, and enhance the use of data for decision-making. During 2013–2017, an electronic surveillance system based on open source software, District Health Information System 2 (DHIS2), was implemented as part of a private sector malaria case management and surveillance programme. The electronic surveillance system covered 16,000 private providers in Myanmar (electronic reporting conducted by 200 field officers with tablets), 710 in Cambodia (585 providers reporting through mobile app), and 432 in Laos (250 providers reporting through mobile app). Methods The purpose of the study was to document the costs of introducing electronic surveillance systems and mobile reporting solutions in Cambodia, Lao PDR, and Myanmar, comparing the cost in different operational settings, the cost of introduction and maintenance over time, and assessing the affordability and financial sustainability of electronic surveillance. The data collection methods included extracting data from PSI’s financial and operational records, collecting data on prices and quantities of resources used, and interviewing key informants in each setting. The costing study used an ingredients-based approach and estimated both financial and economic costs. Results Annual economic costs of electronic surveillance systems were $152,805 in Laos, $263,224 in Cambodia, and $1,310,912 in Myanmar. The annual economic cost per private provider surveilled was $82 in Myanmar, $371 in Cambodia, and $354 in Laos. Cost drivers varied depending on operational settings and number of private sector outlets covered in each country; whether purchased or personal mobile devices were used; and whether electronic (mobile) reporting was introduced at provider level or among field officers who support multiple providers for case reporting. Conclusion The study found that electronic surveillance comprises about 0.5–1.5% of national malaria strategic plan cost and 7–21% of surveillance budgets and deemed to be affordable and financially sustainable. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03727-w.
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Affiliation(s)
- Ann Levin
- Levin & Morgan LLC, Bethesda, MD, USA.
| | | | | | | | - Phally Keo
- Population Services International, Phnom Penh, Cambodia
| | - Elijah Filip
- Clinton Health Access Initiative, Phnom Penh, Cambodia
| | - Si Hein Phone
- Asia Pacific Malaria Elimination Network, Singapore, Singapore
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21
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Gama A, Banda I, Kapaya F, Ingwe MM, Chiwaula J, Yeta A, Kawesha EC, Hamainza B, Chongwe G. Factors associated with private health facilities reporting malaria in the national health management information system in Zambia: a cross sectional study. Pan Afr Med J 2020; 37:203. [PMID: 33505572 PMCID: PMC7813650 DOI: 10.11604/pamj.2020.37.203.18829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/22/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Zambia has moved from accelerated malaria burden reduction to malaria elimination which requires the national malaria surveillance system to capture all cases from both the public and private sector. This study investigated challenges and factors associated with private health facilities reporting malaria in the national health management information system (HMIS). METHODS a structured questionnaire was administered to the heads of 139 private health facilities in three provinces where approximately 85% of private health facilities are found in Zambia. Logistic regression was performed, and the outcome variable was reporting malaria in the HMIS. Epi Info® version 7 was used to conduct multivariable logistic regression to determine factors associated with private facilities reporting malaria in HMIS. RESULTS private health facilities that had been operating for more than 20 years had three (3) times increased odds of reporting malaria in HMIS (AOR = 3.22, 95% CI: 1.23, 8.42; P-value = 0.02) compared to those that had been operating for less than 20 years. The private facilities that had staff who were aware about malaria surveillance (AOR = 2.06 95% CI: 1.38, 3.99, P-value = 0.01) had two times greater odds to report malaria in HMIS compared to those that were not aware. Lack of information and training in surveillance was identified as the main barrier for private facilities to report malaria in HMIS. CONCLUSION as Zambia progresses towards malaria elimination, there is need to increase awareness and training of private providers on malaria surveillance to improve reporting in HMIS.
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Affiliation(s)
- Angela Gama
- Zambia Field Epidemiology Training Programme (ZFETP), Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Ignatius Banda
- Zambia National Malaria Elimination Centre, Lusaka, Zambia
| | - Fred Kapaya
- Zambia Field Epidemiology Training Programme (ZFETP), Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | - Anthony Yeta
- Zambia National Malaria Elimination Centre, Lusaka, Zambia
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22
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Thomas A, Bakai TA, Atcha-Oubou T, Tchadjobo T, Voirin N. Implementation of a malaria sentinel surveillance system in Togo: a pilot study. Malar J 2020; 19:330. [PMID: 32907580 PMCID: PMC7487970 DOI: 10.1186/s12936-020-03399-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background In Togo, the National Malaria Control Programme, in collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria, has implemented a pilot study for malaria sentinel surveillance since 2017, which consists of collecting information in real time and analysing this information for decision-making. The first 20 months of malaria morbidity and mortality trends, and malaria case management in health facilities included in the surveillance were assessed. Methods Since July 2017, 16 health facilities called sentinel sites, 4 hospitals and 12 peripheral care units located in 2 epidemiologically different health regions, have provided weekly data on malaria morbidity and mortality for the following 3 target groups: < 5-years-old children, ≥ 5-years-old children and adults, and pregnant women. Data from week 29 in 2017 to week 13 in 2019 were analysed. Results Each sentinel site provided complete data and the median time to data entry was 4 days. The number of confirmed malaria cases increased during the rainy seasons both in children under 5 years old and in children over 5 years old and adults. Malaria-related deaths occurred mainly in children under 5 years old and increased during the rainy seasons. The mean percentage of tested cases for malaria among suspected malaria cases was 99.0%. The mean percentage of uncomplicated malaria cases handled in accordance with national guidelines was 99.4%. The mean percentage of severe malaria cases detected in peripheral care units that were referred to a hospital was 100.0%. Rapid diagnostic tests and artemisinin-based combination therapies were out of stock several times, mainly at the beginning and end of the year. No hospital was out of stock of injectable artesunate or injectable artemether. Conclusions These indicators showed good management of malaria cases in the sentinel sites. Real-time availability of data requires a good follow-up of data entry on the online platform. The management of input stocks and the promptness of data need to be improved to meet the objectives of this malaria sentinel surveillance system.
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Affiliation(s)
- Anne Thomas
- Epidemiology and Modelling in Infectious Diseases (EPIMOD), Dompierre-sur-Veyle, France
| | - Tchaa A Bakai
- Epidemiology and Modelling in Infectious Diseases (EPIMOD), Dompierre-sur-Veyle, France. .,Programme National de Lutte Contre Le Paludisme (PNLP), Lomé, Togo.
| | | | | | - Nicolas Voirin
- Epidemiology and Modelling in Infectious Diseases (EPIMOD), Dompierre-sur-Veyle, France
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23
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van der Horst T, Al-Mafazy AW, Fakih BS, Stuck L, Ali A, Yukich J, Hetzel MW. Operational Coverage and Timeliness of Reactive Case Detection for Malaria Elimination in Zanzibar, Tanzania. Am J Trop Med Hyg 2020; 102:298-306. [PMID: 31769395 PMCID: PMC7008315 DOI: 10.4269/ajtmh.19-0505] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Since 2012, the Zanzibar Malaria Elimination Program has been implementing reactive case detection (RACD). Health facility (HF) staff send individual malaria case notifications by using mobile phones, triggering a review of HF records and malaria testing and treatment at the household level by a district malaria surveillance officer. We assessed the completeness and timeliness of this system, from case notification to household-level response. We reviewed two years (2015-2016) of primary register information in 40 randomly selected HFs on Zanzibar's two islands Unguja and Pemba and database records of case notifications from all registered HFs for the period 2013-16. The operational coverage of the system was calculated as proportion of HF-registered cases that were successfully reviewed and followed up at their household. Timeliness was defined as completion of each step within 1 day. Public HFs notified almost all registered cases (91% in Unguja and 87% in Pemba), and 74% of cases registered at public HFs were successfully followed up at their household in Unguja and 79% in Pemba. Timely operational coverage (defined as each step, diagnosis to notification, notification to review, and review to household-level response, completed within 1 day) was achieved for only 25% of registered cases in Unguja and 30% in Pemba. Records and data from private HFs on Unguja indicated poor notification performance in the private sector. Although the RACD system in Zanzibar achieved high operational coverage, timeliness was suboptimal. Patients diagnosed with malaria at private HFs and hospitals appeared to be largely missed by the RACD system.
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Affiliation(s)
- Tina van der Horst
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Abdul-Wahid Al-Mafazy
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania.,University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Logan Stuck
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Abdullah Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Joshua Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Manuel W Hetzel
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
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Sidibe A, Maglior A, Cueto C, Chen I, Le Menach A, Chang MA, Eisele TP, Andrinopolous K, Cherubin J, Lemoine JF, Bennett A. Assessing the role of the private sector in surveillance for malaria elimination in Haiti and the Dominican Republic: a qualitative study. Malar J 2019; 18:408. [PMID: 31806025 PMCID: PMC6896765 DOI: 10.1186/s12936-019-3024-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Haiti and the Dominican Republic (DR) are targeting malaria elimination by 2022. The private health sector has been relatively unengaged in these efforts, even though most primary health care in Haiti is provided by non-state actors, and many people use traditional medicine. Data on private health sector participation in malaria elimination efforts are lacking, as are data on care-seeking behaviour of patients in the private health sector. This study sought to describe the role of private health sector providers, care-seeking behaviour of individuals at high risk of malaria, and possible means of engaging the private health sector in Hispaniola's malaria elimination efforts. METHODS In-depth interviews with 26 key informants (e.g. government officials), 62 private providers, and 63 patients of private providers, as well as 12 focus group discussions (FGDs) with community members, were conducted within seven study sites in Haiti and the DR. FGDs focused on local definitions of the private health sector and identified private providers for interview recruitment, while interviews focused on private health sector participation in malaria elimination activities and treatment-seeking behaviour of febrile individuals. RESULTS Interviews revealed that self-medication is the most common first step in the trajectory of care for fevers in both Haiti and the DR. Traditional medicine is more commonly used in Haiti than in the DR, with many patients seeking care from traditional healers before, during, and/or after care in the formal health sector. Private providers were interested in participating in malaria elimination efforts but emphasized the need for ongoing support and training. Key informants agreed that the private health sector needs to be engaged, especially traditional healers in Haiti. The Haitian migrant population was reported to be one of the most at-risk groups by participants from both countries. CONCLUSION Malaria elimination efforts across Hispaniola could be enhanced by engaging traditional healers in Haiti and other private providers with ongoing support and trainings; directing educational messaging to encourage proper treatment-seeking behaviour; and refining cross-border strategies for surveillance of the high-risk migrant population. Increasing distribution of rapid diagnostic tests (RDTs) and bi-therapy to select private health sector facilities, accompanied by adopting regulatory policies, could help increase numbers of reported and correctly treated malaria cases.
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Affiliation(s)
- Abigail Sidibe
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA
| | - Alysse Maglior
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA
| | - Carmen Cueto
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA
| | - Ingrid Chen
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA
| | | | - Michelle A Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas P Eisele
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | | | | | - Adam Bennett
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, CA, USA.
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25
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Feachem RGA, Chen I, Akbari O, Bertozzi-Villa A, Bhatt S, Binka F, Boni MF, Buckee C, Dieleman J, Dondorp A, Eapen A, Sekhri Feachem N, Filler S, Gething P, Gosling R, Haakenstad A, Harvard K, Hatefi A, Jamison D, Jones KE, Karema C, Kamwi RN, Lal A, Larson E, Lees M, Lobo NF, Micah AE, Moonen B, Newby G, Ning X, Pate M, Quiñones M, Roh M, Rolfe B, Shanks D, Singh B, Staley K, Tulloch J, Wegbreit J, Woo HJ, Mpanju-Shumbusho W. Malaria eradication within a generation: ambitious, achievable, and necessary. Lancet 2019; 394:1056-1112. [PMID: 31511196 DOI: 10.1016/s0140-6736(19)31139-0] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/26/2019] [Accepted: 05/07/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Richard G A Feachem
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Ingrid Chen
- Global Health Group, University of California San Francisco, San Francisco, CA, USA.
| | - Omar Akbari
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - Amelia Bertozzi-Villa
- Malaria Atlas Project, University of Oxford, Oxford, UK; Institute for Disease Modeling, Bellevue, WA, USA
| | - Samir Bhatt
- Malaria Atlas Project, University of Oxford, Oxford, UK
| | - Fred Binka
- School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Maciej F Boni
- Center for Infectious Disease Dynamics, Department of Biology, Penn State, University Park, PA, USA
| | - Caroline Buckee
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Joseph Dieleman
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Arjen Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alex Eapen
- National Institute of Malaria Research, Chennai, India
| | - Neelam Sekhri Feachem
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Scott Filler
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Peter Gething
- Malaria Atlas Project, University of Oxford, Oxford, UK
| | - Roly Gosling
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Annie Haakenstad
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Kelly Harvard
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Arian Hatefi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Dean Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kate E Jones
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | | | | | - Altaf Lal
- Sun Pharma Industries, Mumbai, India
| | - Erika Larson
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Lees
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Neil F Lobo
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Angela E Micah
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Bruno Moonen
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Gretchen Newby
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Xiao Ning
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, China
| | - Muhammad Pate
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Martha Quiñones
- Department of Public Health, Universidad Nacional de Colombia, Bogota, Colombia
| | - Michelle Roh
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Ben Rolfe
- Asia Pacific Leaders Malaria Alliance, Singapore
| | | | - Balbir Singh
- Malaria Research Center, University Malaysia Sarawak, Sarawak, Malaysia
| | | | | | - Jennifer Wegbreit
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Hyun Ju Woo
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
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26
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Lourenço C, Tatem AJ, Atkinson PM, Cohen JM, Pindolia D, Bhavnani D, Le Menach A. Strengthening surveillance systems for malaria elimination: a global landscaping of system performance, 2015-2017. Malar J 2019; 18:315. [PMID: 31533740 PMCID: PMC6751607 DOI: 10.1186/s12936-019-2960-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveillance is a core component of an effective system to support malaria elimination. Poor surveillance data will prevent countries from monitoring progress towards elimination and targeting interventions to the last remaining at-risk places. An evaluation of the performance of surveillance systems in 16 countries was conducted to identify key gaps which could be addressed to build effective systems for malaria elimination. METHODS A standardized surveillance system landscaping was conducted between 2015 and 2017 in collaboration with governmental malaria programmes. Malaria surveillance guidelines from the World Health Organization and other technical bodies were used to identify the characteristics of an optimal surveillance system, against which systems of study countries were compared. Data collection was conducted through review of existing material and datasets, and interviews with key stakeholders, and the outcomes were summarized descriptively. Additionally, the cumulative fraction of incident infections reported through surveillance systems was estimated using surveillance data, government records, survey data, and other scientific sources. RESULTS The landscaping identified common gaps across countries related to the lack of surveillance coverage in remote communities or in the private sector, the lack of adequate health information architecture to capture high quality case-based data, poor integration of data from other sources such as intervention information, poor visualization of generated information, and its lack of availability for making programmatic decisions. The median percentage of symptomatic cases captured by the surveillance systems in the 16 countries was estimated to be 37%, mostly driven by the lack of treatment-seeking in the public health sector (64%) or, in countries with large private sectors, the lack of integration of this sector within the surveillance system. CONCLUSIONS The landscaping analysis undertaken provides a clear framework through which to identify multiple gaps in current malaria surveillance systems. While perfect systems are not required to eliminate malaria, closing the gaps identified will allow countries to deploy resources more efficiently, track progress, and accelerate towards malaria elimination. Since the landscaping undertaken here, several countries have addressed some of the identified gaps by improving coverage of surveillance, integrating case data with other information, and strengthening visualization and use of data.
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Affiliation(s)
- Christopher Lourenço
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA.
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Southampton, UK.
| | - Andrew J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Peter M Atkinson
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - Justin M Cohen
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA
| | - Deepa Pindolia
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA
| | - Darlene Bhavnani
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA
| | - Arnaud Le Menach
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA
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Maina JK, Macharia PM, Ouma PO, Snow RW, Okiro EA. Coverage of routine reporting on malaria parasitological testing in Kenya, 2015-2016. Glob Health Action 2018; 10:1413266. [PMID: 29261450 PMCID: PMC5757226 DOI: 10.1080/16549716.2017.1413266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Following the launch of District Health Information System 2 across facilities in Kenya, more health facilities are now capable of carrying out malaria parasitological testing and reporting data as part of routine health information systems, improving the potential value of routine data for accurate and timely tracking of rapidly changing disease epidemiology at fine spatial resolutions. OBJECTIVES This study evaluates the current coverage and completeness of reported malaria parasitological testing data in DHIS2 specifically looking at patterns in geographic coverage of public health facilities in Kenya. METHODS Monthly facility level data on malaria parasitological testing were extracted from Kenya DHIS2 between November 2015 and October 2016. DHIS2 public facilities were matched to a geo-coded master facility list to obtain coordinates. Coverage was defined as the geographic distribution of facilities reporting any data by region. Completeness of reporting was defined as the percentage of facilities reporting any data for the whole 12-month period or for 3, 6 and 9 months. RESULTS Public health facilities were 5,933 (59%) of 10,090 extracted. Fifty-nine per Cent of the public facilities did not report any data while 36, 29 and 22% facilities had data reported at least 3, 6 and 9 months, respectively. Only 8% of public facilities had data reported for every month. There were proportionately more hospitals (86%) than health centres (76%) and dispensaries/clinics (30%) reporting. There were significant geographic variations in reporting rates. Counties along the malaria endemic coast had the lowest reporting rate with only 1% of facilities reporting consistently for 12 months. CONCLUSION Current coverage and completeness of reporting of malaria parasitological diagnosis across Kenya's public health system remains poor. The usefulness of routine data to improve our understanding of sub-national heterogeneity across Kenya would require significant improvements to the consistency and coverage of data captured by DHIS2.
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Affiliation(s)
- Joseph K Maina
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya
| | - Peter M Macharia
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya
| | - Paul O Ouma
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya
| | - Robert W Snow
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya.,b Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine , University of Oxford , Oxford , UK
| | - Emelda A Okiro
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya
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Al Manir MS, Brenas JH, Baker CJ, Shaban-Nejad A. A Surveillance Infrastructure for Malaria Analytics: Provisioning Data Access and Preservation of Interoperability. JMIR Public Health Surveill 2018; 4:e10218. [PMID: 29907554 PMCID: PMC6026300 DOI: 10.2196/10218] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/16/2018] [Accepted: 05/08/2018] [Indexed: 12/19/2022] Open
Abstract
Background According to the World Health Organization, malaria surveillance is weakest in countries and regions with the highest malaria burden. A core obstacle is that the data required to perform malaria surveillance are fragmented in multiple data silos distributed across geographic regions. Furthermore, consistent integrated malaria data sources are few, and a low degree of interoperability exists between them. As a result, it is difficult to identify disease trends and to plan for effective interventions. Objective We propose the Semantics, Interoperability, and Evolution for Malaria Analytics (SIEMA) platform for use in malaria surveillance based on semantic data federation. Using this approach, it is possible to access distributed data, extend and preserve interoperability between multiple dynamic distributed malaria sources, and facilitate detection of system changes that can interrupt mission-critical global surveillance activities. Methods We used Semantic Automated Discovery and Integration (SADI) Semantic Web Services to enable data access and improve interoperability, and the graphical user interface-enabled semantic query engine HYDRA to implement the target queries typical of malaria programs. We implemented a custom algorithm to detect changes to community-developed terminologies, data sources, and services that are core to SIEMA. This algorithm reports to a dashboard. Valet SADI is used to mitigate the impact of changes by rebuilding affected services. Results We developed a prototype surveillance and change management platform from a combination of third-party tools, community-developed terminologies, and custom algorithms. We illustrated a methodology and core infrastructure to facilitate interoperable access to distributed data sources using SADI Semantic Web services. This degree of access makes it possible to implement complex queries needed by our user community with minimal technical skill. We implemented a dashboard that reports on terminology changes that can render the services inactive, jeopardizing system interoperability. Using this information, end users can control and reactively rebuild services to preserve interoperability and minimize service downtime. Conclusions We introduce a framework suitable for use in malaria surveillance that supports the creation of flexible surveillance queries across distributed data resources. The platform provides interoperable access to target data sources, is domain agnostic, and with updates to core terminological resources is readily transferable to other surveillance activities. A dashboard enables users to review changes to the infrastructure and invoke system updates. The platform significantly extends the range of functionalities offered by malaria information systems, beyond the state-of-the-art.
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Affiliation(s)
| | - Jon Haël Brenas
- Oak Ridge National Laboratory Center for for Biomedical Informatics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Christopher Jo Baker
- Department of Computer Science, University of New Brunswick, Saint John, NB, Canada.,IPSNP Computing Inc, Saint John, NB, Canada
| | - Arash Shaban-Nejad
- Oak Ridge National Laboratory Center for for Biomedical Informatics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, United States
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Chen I, Thanh HNT, Lover A, Thao PT, Luu TV, Thang HN, Thang ND, Neukom J, Bennett A. Malaria risk factors and care-seeking behaviour within the private sector among high-risk populations in Vietnam: a qualitative study. Malar J 2017; 16:414. [PMID: 29037242 PMCID: PMC5644094 DOI: 10.1186/s12936-017-2060-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/09/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Vietnam has successfully reduced malaria incidence by more than 90% over the past 10 years, and is now preparing for malaria elimination. However, the remaining malaria burden resides in individuals that are hardest to reach, in highly remote areas, where many malaria cases are treated through the informal private sector and are not reported to public health systems. This qualitative study aimed to contextualize and characterize the role of private providers, care-seeking behaviour of individuals at high risk of malaria, as well as risk factors that should be addressed through malaria elimination programmes in Vietnam. METHODS Semi-structured qualitative interviews were conducted with 11 key informants in Hanoi, 30 providers, 9 potential patients, and 11 individuals at risk of malaria in Binh Phuoc and Kon Tum provinces. Audio recorded interviews were transcribed and uploaded to Atlas TI™, themes were identified, from which programmatic implications and recommendations were synthesized. RESULTS Qualitative interviews revealed that efforts for malaria elimination in Vietnam should concentrate on reaching highest-risk populations in remote areas as well their care providers, in particular private pharmacies, private clinics, and grocery stores. Among these private providers, diagnosis is currently based on symptoms, leaving unconfirmed cases that are not reported to public health surveillance systems. Among at-risk individuals, knowledge of malaria was limited, and individuals reported not taking full courses of treatment, a practice that threatens selection for drug resistance. Access to insecticide-treated hammock nets, a potentially important preventive measure for settings with outdoor biting Anopheles vectors, was also limited. CONCLUSIONS Malaria elimination efforts in Vietnam can be accelerated by targeting improved treatment, diagnosis, and reporting practices to private pharmacies, private clinics, and grocery stores. Programmes should also seek to increase awareness and understanding of malaria among at-risk populations, in particular the importance of using preventive measures and adhering to complete courses of anti-malarial medicines.
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Affiliation(s)
- Ingrid Chen
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Huong Ngo Thi Thanh
- Population Services International Vietnam, VinaFor Building, 127 Lò Đúc, Đồng Xuân, Hanoi, Vietnam
| | - Andrew Lover
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Phung Thi Thao
- Population Services International Vietnam, VinaFor Building, 127 Lò Đúc, Đồng Xuân, Hanoi, Vietnam
| | - Tang Viet Luu
- Population Services International Vietnam, VinaFor Building, 127 Lò Đúc, Đồng Xuân, Hanoi, Vietnam
| | - Hoang Nghia Thang
- Population Services International Vietnam, VinaFor Building, 127 Lò Đúc, Đồng Xuân, Hanoi, Vietnam
| | - Ngo Duc Thang
- National Institute of Malaria, Parasitology, and Entomology (NIMPE), Vietnam, 35 Trung Van, Tu Liem, Hanoi, Vietnam
| | - Josselyn Neukom
- Population Services International Vietnam, VinaFor Building, 127 Lò Đúc, Đồng Xuân, Hanoi, Vietnam
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
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