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Bhamani B, Martí Coma-Cros E, Tusell M, Mithi V, Serra-Casas E, Williams NA, Lindblade KA, Allen KC. Targeted Testing and Treatment To Reduce Human Malaria Transmission in High-Risk Populations: A Systematic Review. Am J Trop Med Hyg 2024; 110:54-64. [PMID: 38471159 PMCID: PMC10993793 DOI: 10.4269/ajtmh.23-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/04/2024] [Indexed: 03/14/2024] Open
Abstract
As countries approach elimination of malaria, groups with increased exposure to malaria vectors or poor access to health services may serve as important human reservoirs of infection that help maintain transmission in the community. Parasitological testing and treatment targeted to these groups may reduce malaria transmission overall. This systematic review assessed the effectiveness of targeted testing and treatment (TTaT) to reduce malaria transmission, the contextual factors, and the results of modeling studies that estimated the intervention's potential impact. Bibliographic searches were conducted in March 2021 and updated in April 2022, and a total of 1,210 articles were identified. Three studies were included for outcome data: one factorial cluster randomized controlled trial (cRCT) in Kenya (5,233 participants), one cRCT in Ghana (3,046 participants), and one controlled before-and-after cohort study in schoolchildren in Malawi (786 participants). Nine reports were included for contextual factors, and two were included for mathematical modeling. Data on outcomes from the three studies suggested that at the community level, TTaT would result in little to no difference in the incidence of malaria infection (measured via active surveillance), adverse events, and severe AEs. In contrast, the effects of TTaT on prevalence (malaria parasitemia) among those targeted by the intervention were found to include a short-term impact on reducing transmission but little to no impact on transmission for extended periods. Future iterations of this review should ensure consideration for populations proven to host the vast majority of the reservoir of infection in lower-transmission settings to determine the effectiveness of the intervention.
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Affiliation(s)
- Beena Bhamani
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Elisabet Martí Coma-Cros
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Maria Tusell
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Vita Mithi
- Armref Data for Action in Public Health Research Consultancy, Mzuzu, Malawi
- Society for Research on Nicotine and Tobacco—Genetics and Omics Network, Madison, Wisconsin
- Leaders of Africa Institute, Baltimore, Maryland
| | - Elisa Serra-Casas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Nana Aba Williams
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Kim A. Lindblade
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Koya C. Allen
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Mhango P, Malata MP, Chipeta E, Sixpence A, Taylor TE, Wilson ML, Cohee LM, Mangani C, Mathanga DP. Barriers to accessing malaria treatment amongst school-age children in rural Malawi. Malar J 2023; 22:258. [PMID: 37674177 PMCID: PMC10481490 DOI: 10.1186/s12936-023-04695-z] [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: 11/10/2022] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Over the last two decades, many countries have moved from malaria control toward malaria elimination. However, some sub-Saharan African countries, like Malawi, have recently seen a reversal in malaria control progress with reported increases in confirmed malaria cases. This may be the result of inadequate access to effective malaria control interventions by key population groups that perpetuate transmission. This study aimed to assess the barriers to accessing malaria treatment among school-aged children (SAC) in Malawi. METHODS A qualitative study was conducted between September and October 2020, where data were gathered in rural Malawi using free-listing interviews, key-informant interviews, semi-structured interviews and focus group discussions. Purposively sampled participants included SAC, parents of SAC, health workers and key stakeholders at community and district levels. Interviews were digitally recorded and transcribed verbatim. Data were organized using NVivo 12 software and analysed using the thematic method. RESULTS The study recruited 252 participants, with 156 being SAC, equally divided between boys and girls. Health system barriers to malaria treatment included long waiting hours and queues at clinics, frequent stock-outs of medical supplies, and travel time to the facility. Provider barriers included negative attitude and limited service hours. Individual and cultural barriers included fear of malaria tests and beliefs associating witchcraft as the best treatment for malaria. In addition, COVID-19-related barriers included the inability to follow preventive measures, a shift in focus from malaria to COVID-19, and fear of contracting COVID-19 and/or being tested for COVID-19 at the facility. CONCLUSIONS This study shows most of the barriers to accessing malaria treatment among SAC are similar to those experienced by other population groups. Furthermore, COVID-19 adversely affected SAC's access to treatment. Interventions that support SAC access to prompt diagnosis and treatment are urgently needed to improve the effective control of malaria.
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Affiliation(s)
- Patani Mhango
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Monica Patricia Malata
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Effie Chipeta
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alick Sixpence
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Don P Mathanga
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
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Zerdo Z, Bastiaens H, Anthierens S, Massebo F, Masne M, Biresaw G, Shewangizaw M, Tunje A, Chisha Y, Yohannes T, Van Geertruyden JP. Effect of malaria prevention education on bed net utilization, incidence of malaria and treatment seeking among school-aged children in Southern Ethiopia; cluster randomized controlled trial. BMC Infect Dis 2023; 23:486. [PMID: 37474930 PMCID: PMC10360348 DOI: 10.1186/s12879-023-08464-w] [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: 06/01/2022] [Accepted: 07/15/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND School-aged children (SAC) have an increased risk to contract malaria and play a major role in its transmission dynamics. However, their malaria prevention experience is poor. Thus, the effect of malaria prevention education (MPE) on bed net utilization, treatment seeking from a health facility and cumulative incidence of malaria was evaluated in Southern Ethiopia. METHODS A two arm cluster randomized controlled trial was conducted by recruiting 2038 SAC from 32 schools. Structured questionnaire was used to collect data on socio-demographic, economic, bed net ownership, bed net utilization, whether the participated child suffered from malaria and has got treatment from a health facility. Generalized mixed effect logistic regression using school as random variable was used to assess the effect of the intervention on the outcome variables. RESULTS The ownership of bed net in households of the control and intervention schools was similar respectively with 84.6 and 88.6% (Crude Odds Ratio (COR): 1.5; 95%CI: 0.5-4.8). The percentage of SAC slept under the bed net the night before the survey was also similar (55.1% versus 54.0%); COR:1.04; 95%CI: 0.5-2.4). Bed net utilization was affected by household size to the bed net ratio ≤ 2 (Adjusted Odds Ratio (AOR) = 1.6; 95%CI:1.3-2.1), bed net utilization at baseline of the study (AOR = 2.3; 95%CI:1.5-3.6), and history of malaria attack in the last twelve months (AOR = 1.3; 95%CI:1.01-1.8). Reported cumulative incidence of malaria and treatment seeking from a health facility by SAC was similar between intervention and control arms: -2.1% (COR = 0.8; 95%CI: 0.5-1.5) and 9.6% (COR = 1.4; 95%CI: 0.4-4.3) respectively. The reported incidence of malaria was affected by altitude (AOR = 0.5; 95%CI: 0.3-0.8), low and medium wealth index (AOR = 0.7; 95%CI: 0.5-0.96 and AOR = 0.7; 95%CI: 0.5-0.98), adequate bed net number for household members (AOR = 0.7; 95%CI:0.5-0.9) and bed net utilization (AOR = 1.3; 95%CI:1.1-1.8). CONCLUSIONS MPE had no significant effect on the use of malaria prevention measures considered, treatment seeking from a health facility and reported cumulative incidence of malaria though bed net use was associated with malaria incidence. Before organizing any health education program, sustainable implementation efforts have to be warranted especially in SAC, a neglected but relevant vulnerable and reservoirs. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR202001837195738, registered 21/01/2020.
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Affiliation(s)
- Zerihun Zerdo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Hilde Bastiaens
- Department of family medicine and population health, Antwerp University, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of family medicine and population health, Antwerp University, Antwerp, Belgium
| | - Fekadu Massebo
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Matewos Masne
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangizaw
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abayneh Tunje
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Yilma Chisha
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tsegaye Yohannes
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Chinkhumba J, Kadzinje V, Jenda G, Kayange M, Mathanga DP. Impact of school-based malaria intervention on primary school teachers' time in Malawi: evidence from a time and motion study. Malar J 2022; 21:301. [PMID: 36289501 PMCID: PMC9607742 DOI: 10.1186/s12936-022-04324-1] [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: 07/05/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND School-based health (SBH) programmes that are contingent on primary school teachers are options to increase access to malaria treatment among learners. However, perceptions that provision of healthcare by teachers may be detrimental to teaching activities can undermine efforts to scale up school-based malaria control. The objective of this study was to assess the impact of school-based malaria diagnosis and treatment using the Learner Treatment Kit (LTK) on teachers' time. METHODS A time and motion study was conducted in 10 primary schools in rural Malawi. Teachers who had been trained to diagnose and treat uncomplicated malaria were continuously observed in real time during school sessions and the time they spent on all activities were recorded by independent observers before and after LTK implementation. A structured form, programmed digitally, was used for data collection. Paired sample t-tests were used to assess pre-post differences in average hours teachers spent on the following key activities: direct teaching; indirect teaching; administration; LTK and non-teaching tasks. Multivariable repeated measures mixed regression models were used to ascertain impact of LTK on average durations teachers spent on the key activities. RESULTS Seventy-four teachers, trained to use LTK, were observed. Their mean age and years of teaching experience were 34.7 and 8.7, respectively. Overall, 739.8 h of teacher observations took place. The average time teachers spent in school before relative to after LTK was 5.8 vs. 4.8 h, p = 0.01. The cumulative percentage of time teachers spent on core teaching activities (teaching and administration) was approximately 76% and did not change substantially before and after LTK. Some 24.3% of teachers' time is spent on non-teaching activities. On average, teachers spent 2.9% of their time providing LTK services daily. Per day, each teacher spent less time on administrative (0.74 vs. 1.07 h, p = 0.02) and non-teaching activities (0.96 vs. 1.41 h, p = 0.01) during LTK compared with the period before LTK. CONCLUSION School-based health (SBH) programmes are not detrimental to teaching activities. Teachers manage their time to ensure additional time required for SBH services is not at the expense of teaching duties. Programming and policy implications of tasking teachers with SBH does not have substantial opportunity costs. Teachers should continue delivering SBH programmes to promote learners' health.
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Affiliation(s)
- Jobiba Chinkhumba
- School of Public Health and Family Medicine, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi ,Health Economics and Policy Unit, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victor Kadzinje
- Save the Children International, Malawi Office, Lilongwe, Malawi
| | - Gomezgani Jenda
- Save the Children International, Malawi Office, Lilongwe, Malawi
| | - Michael Kayange
- grid.415722.70000 0004 0598 3405Ministry of Health, National Malaria Control Programme, Lilongwe, Malawi
| | - Don P. Mathanga
- School of Public Health and Family Medicine, Department of Community Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Nahum AS, Vongsachang H, Friedman DS, Collins ME. Parental Trust in School-Based Health Care: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:79-91. [PMID: 34773404 DOI: 10.1111/josh.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/18/2021] [Accepted: 04/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Health care delivery in schools is a frequently adopted approach to reduce health care inequalities. Lack of parental trust has been identified as impacting participation in school-based health care programs (SBHPs). The aim of our systematic review is to outline themes related to parental trust in SBHPs. METHODS We searched MEDLINE, Embase, CINHAL, ERIC, PsycInfo, and Web of Science for articles published between 1969 and 2019. Eligible studies (1) were peer-reviewed primary research articles; (2) were school-based health interventions or screening programs; (3) included parental trust data; and (4) were carried out on schoolchildren from pre-K to grade 12. Study location, data collection date, number of participants, demographics, intervention type, study aim and methodology, and all trust themes mentioned, were extracted. Studies were critically appraised using the CASP checklist for qualitative research. RESULTS We identified 9 themes related to parental trust in SBHPs: (1) safety; (2) effectiveness; (3) health professionals' training and credentials; (4) communication; (5) confidentiality; (6) providers; (7) government, authorities, and health service; (8) the pharmaceutical industry; and (9) research and data sharing. CONCLUSIONS The themes identified provide a framework for examining trust in SBHPs, and may guide the development of interventions to increase trust and engagement in SBHPs.
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Affiliation(s)
- Andrea S Nahum
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287
- UCL Medical School, University College London, 74 Huntley Street, Bloomsbury, London, WC1E 6DE, UK
| | - Hursuong Vongsachang
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Glaucoma Center of Excellence, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Megan E Collins
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
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Smith JL, Mumbengegwi D, Haindongo E, Cueto C, Roberts KW, Gosling R, Uusiku P, Kleinschmidt I, Bennett A, Sturrock HJ. Malaria risk factors in northern Namibia: The importance of occupation, age and mobility in characterizing high-risk populations. PLoS One 2021; 16:e0252690. [PMID: 34170917 PMCID: PMC8232432 DOI: 10.1371/journal.pone.0252690] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
In areas of low and unstable transmission, malaria cases occur in populations with lower access to malaria services and interventions, and in groups with specific malaria risk exposures often away from the household. In support of the Namibian National Vector Borne Disease Program's drive to better target interventions based upon risk, we implemented a health facility-based case control study aimed to identify risk factors for symptomatic malaria in Zambezi Region, northern Namibia. A total of 770 febrile individuals reporting to 6 health facilities and testing positive by rapid diagnostic test (RDT) between February 2015 and April 2016 were recruited as cases; 641 febrile individuals testing negative by RDT at the same health facilities through June 2016 were recruited as controls. Data on socio-demographics, housing construction, overnight travel, use of malaria prevention and outdoor behaviors at night were collected through interview and recorded on a tablet-based questionnaire. Remotely-sensed environmental data were extracted for geo-located village residence locations. Multivariable logistic regression was conducted to identify risk factors and latent class analyses (LCA) used to identify and characterize high-risk subgroups. The majority of participants (87% of cases and 69% of controls) were recruited during the 2016 transmission season, an outbreak year in Southern Africa. After adjustment, cases were more likely to be cattle herders (Adjusted Odds Ratio (aOR): 4.46 95%CI 1.05-18.96), members of the police or other security personnel (aOR: 4.60 95%CI: 1.16-18.16), and pensioners/unemployed persons (aOR: 2.25 95%CI 1.24-4.08), compared to agricultural workers (most common category). Children (aOR 2.28 95%CI 1.13-4.59) and self-identified students were at higher risk of malaria (aOR: 4.32 95%CI 2.31-8.10). Other actionable risk factors for malaria included housing and behavioral characteristics, including traditional home construction and sleeping in an open structure (versus modern structure: aOR: 2.01 95%CI 1.45-2.79 and aOR: 4.76 95%CI: 2.14-10.57); cross border travel in the prior 30 days (aOR: 10.55 95%CI 2.94-37.84); and outdoor agricultural work at night (aOR: 2.09 95%CI 1.12-3.87). Malaria preventive activities were all protective and included personal use of an insecticide treated net (ITN) (aOR: 0.61 95%CI 0.42-0.87), adequate household ITN coverage (aOR: 0.63 95%CI 0.42-0.94), and household indoor residual spraying (IRS) in the past year (versus never sprayed: (aOR: 0.63 95%CI 0.44-0.90). A number of environmental factors were associated with increased risk of malaria, including lower temperatures, higher rainfall and increased vegetation for the 30 days prior to diagnosis and residing more than 5 minutes from a health facility. LCA identified six classes of cases, with class membership strongly correlated with occupation, age and select behavioral risk factors. Use of ITNs and IRS coverage was similarly low across classes. For malaria elimination these high-risk groups will need targeted and tailored intervention strategies, for example, by implementing alternative delivery methods of interventions through schools and worksites, as well as the use of specific interventions that address outdoor transmission.
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Affiliation(s)
- Jennifer L. Smith
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Davis Mumbengegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Erastus Haindongo
- School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Carmen Cueto
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Kathryn W. Roberts
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Petrina Uusiku
- National Ministry of Health and Social Services, Windhoek, Namibia
| | - Immo Kleinschmidt
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Hugh J. Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco (UCSF), San Francisco, California, United States of America
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Srinivas ML, Yang EJ, Shrestha P, Wu D, Peeling RW, Tucker JD. Social innovation in diagnostics: three case studies. Infect Dis Poverty 2020; 9:20. [PMID: 32070433 PMCID: PMC7029594 DOI: 10.1186/s40249-020-0633-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/23/2020] [Indexed: 01/04/2023] Open
Abstract
Background Diagnostics are essential for identifying and controlling diseases. However, limited access to diagnostics hinders public health efforts in many settings. Social innovation may provide a framework for expanding access to diagnostics in the global south. Here social innovation is defined as implementing a known public health tool via a novel, community-driven technique. Main Body In this article, we discuss three diverse cases that show the potential for using social innovation in diagnostics. The cases chosen for inclusion here demonstrate the importance of social innovation in diagnostics across different geographic, cultural, and health system contexts. They include malaria testing via schools in Malawi, cervical human papillomavirus (HPV) sample self-collection in Peru, and crowdsourcing human immunodeficiency virus (HIV) testing in China. For each case, we present the public health problem and the impact of using social innovation to increase accessibility of diagnostics. We discuss implications of each diagnostic approach and the importance of social innovation in creating these potential solutions. We argue that social innovation is useful in improving the delivery of essential diagnostic tools in low- and middle-income countries. Conclusions Interventions in Malawi, Peru, and China suggest social innovation increases uptake of diagnostics. The same tools and principles utilized in these cases can be adapted for use in other contexts. Such diagnostic innovations may help improve identification of and linkage to care for many diseases. The approach presents a unique opportunity to better address public health issues and increase accessibility in LMIC health systems.
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Affiliation(s)
- Megan L Srinivas
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Eileen J Yang
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Priyanka Shrestha
- International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Dan Wu
- International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosanna W Peeling
- International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D Tucker
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,International Diagnostics Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Halliday KE, Witek-McManus SS, Opondo C, Mtali A, Allen E, Bauleni A, Ndau S, Phondiwa E, Ali D, Kachigunda V, Sande JH, Jawati M, Verney A, Chimuna T, Melody D, Moestue H, Roschnik N, Brooker SJ, Mathanga DP. Impact of school-based malaria case management on school attendance, health and education outcomes: a cluster randomised trial in southern Malawi. BMJ Glob Health 2020; 5:e001666. [PMID: 32133163 PMCID: PMC7042571 DOI: 10.1136/bmjgh-2019-001666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Evidence indicates children who suffer from ill-health are less likely to attend or complete schooling. Malaria is an important cause of morbidity and mortality in school-age children. However, they are less likely to receive malaria treatment at health facilities and evidence for how to improve schoolchildren's access to care is limited. This study aimed to evaluate the impact of a programme of school-based malaria case management on schoolchildren's attendance, health and education. Methods A cluster randomised controlled trial was conducted in 58 primary schools in Zomba District, Malawi, 2011-2015. The intervention, implemented in 29 randomly selected schools, provided malaria rapid diagnostic tests and artemisinin-based combination therapy to diagnose and treat uncomplicated malaria as part of basic first aid kits known as 'Learner Treatment Kits' (LTK). The primary outcome was school attendance, assessed through teacher-recorded daily attendance registers and independent periodic attendance spot checks. Secondary outcomes included prevalence of Plasmodium spp infection, anaemia, educational performance, self-reported child well-being and health-seeking behaviour. A total of 9571 children from standards 1-7 were randomly selected for assessment of school attendance, with subsamples assessed for the secondary outcomes. Results Between November 2013 and March 2015, 97 trained teachers in 29 schools provided 32 685 unique consultations. Female schoolchildren were significantly more likely than male to seek a consultation (unadjusted OR=1.78 (95% CI 1.58 to 2.00). No significant intervention effect was observed on the proportion of child-days recorded as absent in teacher registers (n=9017 OR=0.90 (95% CI 0.77 to 1.05), p=0.173) or of children absent during random school visits-spot checks (n=5791 OR=1.09 (95% CI 0.87 to 1.36), p=0.474). There was no significant impact on child-reported well-being, prevalence of Plasmodium spp, anaemia or education scores. Conclusion Despite high community demand, the LTK programme did not reduce schoolchildren's absenteeism or improve health or education outcomes in this study setting. Trial registration number ClinicalTrials.gov NCT02213211.
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Affiliation(s)
- Katherine E Halliday
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Stefan S Witek-McManus
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Andrew Bauleni
- Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Saidi Ndau
- Zomba District Health Office, Ministry of Health, Zomba, Malawi
| | - Emmanuel Phondiwa
- District Education Office, Ministry of Education, Science and Technology, Zomba, Malawi
| | - Doreen Ali
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Virginia Kachigunda
- Department of School Health, Nutrition, HIV & AIDS, Ministry of Education, Science and Technology, Lilongwe, Malawi
| | - John H Sande
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | | | | | | | - David Melody
- Save the Children International, Lilongwe, Malawi
| | | | | | - Simon J Brooker
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Don P Mathanga
- Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
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Thera MA, Kone AK, Tangara B, Diarra E, Niare S, Dembele A, Sissoko MS, Doumbo OK. School-aged children based seasonal malaria chemoprevention using artesunate-amodiaquine in Mali. Parasite Epidemiol Control 2018; 3:96-105. [PMID: 29988270 PMCID: PMC6011810 DOI: 10.1016/j.parepi.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 11/01/2022] Open
Abstract
Introduction Malaria is still a public health problem in Africa. Seasonal Malaria Chemoprevention (SMC) is an efficient control strategy recommended by WHO that targets children under five year old living in areas of seasonal malaria transmission. SMC uses the combination amodiaquine (AQ) - sulfadoxine-pyrimethamine (SP). However SP selects rapidly drug resistant parasites. And malaria burden may increase in older children where SMC is implemented. We initiated a pilot study to assess an alternative approach to SMC in older children in Mali. Methods A randomized open-label clinical trial was conducted to test the efficacy and safety of SMC using artesunate - amodiaquine in school aged children in Mali. Two hundred pupils aged 6-15 years old were enrolled and randomized into two arms of 100 each, to receive either artesunate-amodiaquine (ASAQ) monthly or no intervention. Both arms were followed and clinical malaria were diagnosed and treated with arthemeter-lumefanthrine as recommended by Mali National Malaria Control Program. ASAQ was administered 3 days under study team direct observation and during 4 consecutive months starting in October 2013. Follow up was continued until April 2014. Results Overall, 20 cases of uncomplicated clinical malaria were encountered in the Control arm and three cases in the ASAQ arm, showing a protective efficacy of 85% 95% CI [80.1-89.9] against clinical malaria. Protective efficacy against malaria infection was 69.6% 95% CI [58.6-21.4]. No effect on anemia was observed. ASAQ was well tolerated. Most common solicited adverse events were abdominal pain and headaches of mild intensity in respectively 64% and 44% of children that swallowed ASAQ. Conclusion ASAQ is effective and well tolerated as SMC targeting older children in a peri urban setting in Mali. Its administration at schools is a feasible and accepted strategy to deliver the intervention.
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Affiliation(s)
- Mahamadou A Thera
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Abdoulaye K Kone
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Bourama Tangara
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Elizabeth Diarra
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Sirama Niare
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Abdramane Dembele
- Service of Psychiatry, University and Hospital Center of Point G, Bamako, Mali
| | - Mahamadou S Sissoko
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Ogobara K Doumbo
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
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