1
|
Yu Q, Qu Y, Zhang L, Yao X, Yang J, Chen S, Liu H, Wang Q, Wu M, Tao J, Zhou C, Alage IL, Liu S. Spatial spillovers of violent conflict amplify the impacts of climate variability on malaria risk in sub-Saharan Africa. Proc Natl Acad Sci U S A 2024; 121:e2309087121. [PMID: 38557184 PMCID: PMC11009658 DOI: 10.1073/pnas.2309087121] [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: 05/31/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
Africa carries a disproportionately high share of the global malaria burden, accounting for 94% of malaria cases and deaths worldwide in 2019. It is also a politically unstable region and the most vulnerable continent to climate change in recent decades. Knowledge about the modifying impacts of violent conflict on climate-malaria relationships remains limited. Here, we quantify the associations between violent conflict, climate variability, and malaria risk in sub-Saharan Africa using health surveys from 128,326 individuals, historical climate data, and 17,429 recorded violent conflicts from 2006 to 2017. We observe that spatial spillovers of violent conflict (SSVCs) have spatially distant effects on malaria risk. Malaria risk induced by SSVCs within 50 to 100 km from the households gradually increases from 0.1% (not significant, P>0.05) to 6.5% (95% CI: 0 to 13.0%). SSVCs significantly promote malaria risk within the average 20.1 to 26.9 °C range. At the 12-mo mean temperature of 22.5 °C, conflict deaths have the largest impact on malaria risk, with an approximately 5.8% increase (95% CI: 1.0 to 11.0%). Additionally, a pronounced association between SSVCs and malaria risk exists in the regions with 9.2 wet days per month. The results reveal that SSVCs increase population exposure to harsh environments, amplifying the effect of warm temperature and persistent precipitation on malaria transmission. Violent conflict therefore poses a substantial barrier to mosquito control and malaria elimination efforts in sub-Saharan Africa. Our findings support effective targeting of treatment programs and vector control activities in conflict-affected regions with a high malaria risk.
Collapse
Affiliation(s)
- Qiwei Yu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Ying Qu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Liqiang Zhang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Xin Yao
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Jing Yang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Siyuan Chen
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Hui Liu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Qihao Wang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Mengfan Wu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Junpei Tao
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Chenghu Zhou
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Science and Natural Resources, Chinese Academy of Sciences, Beijing100101, China
| | - Isiaka Lukman Alage
- Space Research and Development Division, African Regional Centre for Space Science and Technology Education in English Ile ife, Ile ife, Osun220282, Nigeria
| | - Suhong Liu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| |
Collapse
|
2
|
Groger M, Lutete GT, Assi SB, Bigoga JD, Ntamabyaliro NY, Arbe-Barnes S, Shin J, Adegnika AA, Ntoumi F, Kremsner PG, Ramharter M, Duparc S, Borghini-Fuhrer I, Mombo-Ngoma G. Community health workers in clinical research at the example of a phase IIIb/ IV antimalarial drug trial conducted in five African countries. Int J Infect Dis 2023; 137:114-117. [PMID: 37871675 PMCID: PMC10689247 DOI: 10.1016/j.ijid.2023.10.016] [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: 08/07/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
Global health, particularly in underserved settings can benefit immensely from well-trained community health workers (CHWs) supporting primary healthcare interventions. They can reduce morbidity and mortality of infectious diseases like malaria. Disease control programs can particularly benefit from a tight link between CHWs and communities and several studies have shown the benefit of the participation of non-facility-based CHWs in malaria control program activities for reducing malaria-related mortality in children. Because CHWs are often part of and trusted by served communities, they can also be an important resource to address challenges faced by their communities. Where post-marketing surveillance systems are underserved, they can relay important information about suspected safety signals and factors affecting therapeutic effectiveness in their communities. The CANTAM-Pyramax® trial was a phase IIIb/ IV cohort event monitoring study conducted at six centers in five African countries. To assess real-world effectiveness and safety of the anti-malarial pyronaridine-artesunate in 8560 malaria episodes, follow-up was not primarily conducted by medical staff but by specifically trained CHWs. This perspective paper discusses how the participation of a CHW workforce can be of benefit for effectiveness trials in limited-resource settings, using the example of the CANTAM-Pyramax trial.
Collapse
Affiliation(s)
- Mirjam Groger
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Center of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gaston Tona Lutete
- Unité de Pharmacologie Clinique et Pharmacovigilance (UPC-PV), University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Serge-Brice Assi
- Institut Pierre Richet/Institut National de Santé Publique (IPR/INSP), Bouaké, Côte d'Ivoire
| | - Jude D Bigoga
- The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Nsengi Y Ntamabyaliro
- Unité de Pharmacologie Clinique et Pharmacovigilance (UPC-PV), University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Jangsik Shin
- Shin Poong Pharmaceutical, Seoul, Republic of Korea
| | - Ayola A Adegnika
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; German Center for Infection Research (DZIF), Tübingen, Germany
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), WHO-AFRO Campus Djoué, Brazzaville, Hospital of Talangai (North) of Brazzaville, Republic of Congo
| | - Peter G Kremsner
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; German Center for Infection Research (DZIF), Tübingen, Germany
| | - Michael Ramharter
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Center of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Ghyslain Mombo-Ngoma
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Hassan M, Saif K, Ijaz MS, Sarfraz Z, Sarfraz A, Robles-Velasco K, Cherrez-Ojeda I. Mean Temperature and Drought Projections in Central Africa: A Population-Based Study of Food Insecurity, Childhood Malnutrition and Mortality, and Infectious Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2697. [PMID: 36768062 PMCID: PMC9915533 DOI: 10.3390/ijerph20032697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The Central African Region is an agricultural and fishing-based economy, with 40% of the population living in rural communities. The negative impacts of climate change have caused economic/health-related adverse impacts and food insecurity. This original article aims to research four key themes: (i) acute food insecurity (AFI); (ii) childhood malnutrition and mortality; (iii) infectious disease burden; and (iv) drought and mean temperature projections throughout the twenty-first century. Food insecurity was mapped in Central Africa based on the Integrated Food Security Phase Classification (IPC) for AFI. The global hunger index (GHI) was presented along with the proportion of children with undernourishment, stunting, wasting, and mortality. Data for infectious disease burden was computed by assessing the adjusted rate of change (AROC) of mortality due to diarrhea among children and the burden of death rates due to pneumonia across all age groups. Finally, the mean drought index was computed through the year 2100. This population-based study identifies high levels of hunger across a majority of the countries, with the mean drought index suggesting extreme ends of wet and dry days and an overall rise of 1-3 °C. This study is a source of evidence for stakeholders, policymakers, and the population residing in Central Africa.
Collapse
Affiliation(s)
- Munum Hassan
- Department of Research, Akhtar Saeed Medical College, University of Health Sciences, Lahore 54000, Pakistan
| | - Kinza Saif
- Department of Research, Wah Medical College, University of Health Sciences, Wah Cantt 47000, Pakistan
| | - Muhammad Saad Ijaz
- Department of Research, Rawalpindi Medical University, Rawalpindi 46000, Pakistan
| | - Zouina Sarfraz
- Department of Research and Publications, Fatima Jinnah Medical University, Lahore 54000, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Karla Robles-Velasco
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
| | - Ivan Cherrez-Ojeda
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
| |
Collapse
|
4
|
Nzoumbou-Boko R, Velut G, Imboumy-Limoukou RK, Manirakiza A, Lekana-Douki JB. Malaria research in the Central African Republic from 1987 to 2020: an overview. Trop Med Health 2022; 50:70. [PMID: 36131331 PMCID: PMC9490699 DOI: 10.1186/s41182-022-00446-z] [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: 05/08/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
Background The national malaria control policy in the Central African Republic (CAR) promotes basic, clinical, and operational research on malaria in collaboration with national and international research institutions. Preparatory work for the elaboration of National Strategic Plans for the implementation of the national malaria control policy includes developing the research component, thus requiring an overview of national malaria research. Here, this survey aims to provide an inventory of malaria research as a baseline for guiding researchers and health authorities in choosing the future avenues of research. Methods Data sources and search strategy were defined to query the online Medline/PubMed database using the “medical subject headings” tool. Eligibility and study inclusion criteria were applied to the selected articles, which were classified based on year, research institute affiliations, and research topic. Results A total of 118 articles were retrieved and 51 articles were ultimately chosen for the bibliometric analysis. The number of publications on malaria has increased over time from 1987 to 2020. These articles were published in 32 different journals, the most represented being the Malaria Journal (13.73%) and the American Journal of Tropical Medicine and Hygiene (11.76%). The leading research topics were drug evaluation (52.94%), expatriate patients (23.54%), malaria in children (17.65%), morbidity (13.7%), and malaria during pregnancy (11.76%). The publications’ authors were mainly affiliated with the Institut Pasteur of Bangui (41%), the French Military Medical Service (15.5%), and the University of Bangui (11.7%). Collaborations were mostly established with France, the UK, and the USA; some collaborations involved Switzerland, Austria, Pakistan, Japan, Sri Lanka, Benin, Cameroun, Ivory Coast, and Madagascar. The main sources of research funding were French agencies (28.6%) and international agencies (18.3%). Most studies included were not representative of the whole country. The CAR has the capacity to carry out research on malaria and to ensure the necessary collaborations. Conclusion Malaria research activities in the CAR seem to reflect the priorities of national policy. One remaining challenge is to develop a more representative approach to better characterize malaria cases across the country. Finally, future research and control measures need to integrate the effect of COVID-19.
Collapse
Affiliation(s)
- Romaric Nzoumbou-Boko
- Laboratoire de Parasitologie, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic.
| | - Guillaume Velut
- French Military Health Service, French Armed Forces Centre for Epidemiology and Public Health (CESPA), Marseille, France
| | - Romeo-Karl Imboumy-Limoukou
- Unité Évolution, Épidémiologie Et Résistances Parasitaires (UNEEREP), Centre International de Recherche Médicale de Franceville (CIRMF), BP769, Franceville, Gabon
| | - Alexandre Manirakiza
- Service d'épidémiologie, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic
| | - Jean-Bernard Lekana-Douki
- Unité Évolution, Épidémiologie Et Résistances Parasitaires (UNEEREP), Centre International de Recherche Médicale de Franceville (CIRMF), BP769, Franceville, Gabon.,Département de Parasitologie-Mycologie Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, Libreville, B.P. 4009, Franceville, Gabon
| |
Collapse
|
5
|
Werner K, Kak M, Herbst CH, Lin TK. The role of community health worker-based care in post-conflict settings: a systematic review. Health Policy Plan 2022; 38:261-274. [PMID: 36124928 PMCID: PMC9923383 DOI: 10.1093/heapol/czac072] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/28/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022] Open
Abstract
Countries affected by conflict often experience the deterioration of health system infrastructure and weaken service delivery. Evidence suggests that healthcare services that leverage local community dynamics may ameliorate health system-related challenges; however, little is known about implementing these interventions in contexts where formal delivery of care is hampered subsequent to conflict. We reviewed the evidence on community health worker (CHW)-delivered healthcare in conflict-affected settings and synthesized reported information on the effectiveness of interventions and characteristics of care delivery. We conducted a systematic review of studies in OVID MedLine, Web of Science, Embase, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINHAL) and Google Scholar databases. Included studies (1) described a context that is post-conflict, conflict-affected or impacted by war or crisis; (2) examined the delivery of healthcare by CHWs in the community; (3) reported a specific outcome connected to CHWs or community-based healthcare; (4) were available in English, Spanish or French and (5) were published between 1 January 2000 and 6 May 2021. We identified 1976 articles, of which 55 met the inclusion criteria. Nineteen countries were represented, and five categories of disease were assessed. Evidence suggests that CHW interventions not only may be effective but also efficient in circumventing the barriers associated with access to care in conflict-affected areas. CHWs may leverage their physical proximity and social connection to the community they serve to improve care by facilitating access to care, strengthening disease detection and improving adherence to care. Specifically, case management (e.g. integrated community case management) was documented to be effective in improving a wide range of health outcomes and should be considered as a strategy to reduce barrier to access in hard-to-reach areas. Furthermore, task-sharing strategies have been emphasized as a common mechanism for incorporating CHWs into health systems.
Collapse
Affiliation(s)
- Kalin Werner
- *Corresponding author. Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois Street, 12th Floor, Box 0646, San Francisco, CA 94158, USA. E-mail:
| | - Mohini Kak
- Health, Nutrition and Population Global Practice, The World Bank, 1818 H Street, N.W., Washington, DC 20433, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, 1818 H Street, N.W., Washington, DC 20433, USA
| | - Tracy Kuo Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois Street, 12th Floor, Box 0646, San Francisco, CA 94158, USA
| |
Collapse
|
6
|
Palma-Cuero M, Machado MB, Graça JTB, Anjos NBD, Pereira RS, Suárez-Mutis MC. Malaria at international borders: challenges for elimination on the remote Brazil-Peru border. Rev Inst Med Trop Sao Paulo 2022; 64:e29. [PMID: 35384960 PMCID: PMC8993150 DOI: 10.1590/s1678-9946202264029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
Understanding local epidemiology is essential to reduce the burden of malaria in
complex contexts, such as Brazilian municipalities that share borders with
endemic countries. A descriptive study of malaria in the period 2003 to 2020 was
conducted using data from the Malaria Epidemiological Surveillance Information
System related to a remote municipality with an extensive border with Peru to
understand the disease transmission, focusing on the obstacles to its
elimination. The transmission increases at the end of the rainy season. During
the period of 18 years, 53,575 malaria cases were reported (Mean of API 224.7
cases/1,000), of which 11% were imported from Peru. Thirteen outbreaks of
malaria were observed during the studied period, the last one in 2018. The
highest burden of cases was caused by P. vivax (73.2%), but
P. falciparum was also prevalent at the beginning of the
study period (50% in 2006). Several changes in the epidemiological risk were
observed: (1) the proportion of international imported cases of malaria changed
from 30.7% in 2003 to 3.5% in 2020 (p<0.05); (2) indigenous people affected
increased from 24.3% in 2003 to 89.5% in 2020 (p<0.0001); (3) infected
children and adolescents < 15 years old increased from 50.2% in 2003 to 67.4%
in 2020 (p<0.01); (4) the proportion of men decreased from 56.7% in 2003 to
50.4% in 2020 (p<0.01); (5) the likelihood of P. falciparum
malaria has significantly declined (p<0.01). The number of cases and the
incidence of malaria in 2019 and 2020 were the lowest in the period of 18 years.
The burden of malaria in indigenous areas and its determinants, seasonality,
geographical access and the long international border are obstacles for the
elimination of malaria that must be overcome.
Collapse
Affiliation(s)
- Monica Palma-Cuero
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Programa de Pós-Graduação em Medicina Tropical, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Myrna Barata Machado
- Fundação de Vigilância em Saúde do Amazonas Dra Rosemary Costa Pinto, Manaus, Amazonas, Brazil
| | | | | | - Rafael Santos Pereira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Martha Cecilia Suárez-Mutis
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
7
|
Abujaber N, Vallières F, McBride KA, Sheaf G, Blum PT, Wiedemann N, Travers Á. Examining the evidence for best practice guidelines in supportive supervision of lay health care providers in humanitarian emergencies: A systematic scoping review. J Glob Health 2022; 12:04017. [PMID: 35265328 PMCID: PMC8876157 DOI: 10.7189/jogh.12.04017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nadeen Abujaber
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland
| | - Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland
| | - Kelly A McBride
- International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Greg Sheaf
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland
| | - Pia Tingsted Blum
- International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Nana Wiedemann
- International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Áine Travers
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland
| |
Collapse
|
8
|
Polonsky JA, Bhatia S, Fraser K, Hamlet A, Skarp J, Stopard IJ, Hugonnet S, Kaiser L, Lengeler C, Blanchet K, Spiegel P. Feasibility, acceptability, and effectiveness of non-pharmaceutical interventions against infectious diseases among crisis-affected populations: a scoping review. Infect Dis Poverty 2022; 11:14. [PMID: 35090570 PMCID: PMC8796190 DOI: 10.1186/s40249-022-00935-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/03/2022] [Indexed: 12/23/2022] Open
Abstract
Background Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements. Methods We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality. Results Our review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness. Conclusions Overall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-00935-7.
Collapse
|
9
|
Pinto RM, Rahman R, Zanchetta MS, Galhego-Garcia W. Brazil's Community Health Workers Practicing Narrative Medicine: Patients' Perspectives. J Gen Intern Med 2021; 36:3743-3751. [PMID: 33826059 PMCID: PMC8642505 DOI: 10.1007/s11606-021-06730-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. OBJECTIVE To document how CHWs apply specific NM concepts in Brazil's Family Health Strategy (FHS), the key component of Brazil's Unified Health System. DESIGN We used a semi-structured interview, grounded in Charon's (2001) framework, including four types of NM relationships: provider-patient, provider-colleague, provider-society, and provider-self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. KEY RESULTS Sample: 18 females; 13 White, 12 "Pardo" (mixed races), 12 Black. We found: (1) provider-patient relationship-CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider-colleague relationship-CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider-society relationship-CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider-self relationship-patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. CONCLUSION This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider-colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider-self relationship. Public education on CHWs' roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs' personality traits may influence their ability to apply NM.
Collapse
Affiliation(s)
| | - Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | | | - W Galhego-Garcia
- Department of Basic Sciences, Faculty of Dentistry of Araçatuba, Estadual Paulista University, São Paulo, Brazil
| |
Collapse
|
10
|
Lutwama GW, Kok M, Jacobs E. An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan. Confl Health 2021; 15:82. [PMID: 34794466 PMCID: PMC8600860 DOI: 10.1186/s13031-021-00422-0] [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: 02/17/2021] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019. Methods The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs. Results Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common. Conclusion Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.
Collapse
Affiliation(s)
- George William Lutwama
- Health Pooled Fund, American Embassy Residency Road, Juba, South Sudan. .,KIT Health, Royal Tropical Institute, Mauritskade 63, Amsterdam, 1090 HA, The Netherlands.
| | - Maryse Kok
- KIT Health, Royal Tropical Institute, Mauritskade 63, Amsterdam, 1090 HA, The Netherlands
| | - Eelco Jacobs
- KIT Health, Royal Tropical Institute, Mauritskade 63, Amsterdam, 1090 HA, The Netherlands
| |
Collapse
|
11
|
Miller NP, Ardestani FB, Dini HS, Shafique F, Zunong N. Community health workers in humanitarian settings: Scoping review. J Glob Health 2021; 10:020602. [PMID: 33312508 PMCID: PMC7719274 DOI: 10.7189/jogh.10.020602] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background There is a need for greater understanding of experiences implementing community-based primary health care in humanitarian settings and of the adjustments needed to ensure continuation of essential services and utilization of services by the population, and to contribute to effective emergency response. We reviewed the evidence base on community health workers (CHWs) in humanitarian settings, with the goal of improving delivery of essential services to the most vulnerable populations. Methods We conducted a scoping review of published and grey literature related to health and nutrition services provided by CHWs in humanitarian settings. Extracted data from retained documents were analyzed inductively for key themes. Results Of 3709 documents screened, 219 were included in the review. Key findings from the literature include: 1) CHWs were often able to continue providing services during acute and protracted crises, including prolonged periods of conflict and insecurity and during population displacement. 2) CHWs carried out critical emergency response activities during acute crises. 3) Flexible funding facilitated transitions between development and humanitarian programming. 4) Communities that did not have a locally-resident CHW experienced reduced access to services when travel was limited. 5) Community selection of CHWs and engagement of respected local leaders were crucial for community trust and acceptance and high utilization of services. 6) Selection of local supervisors and use of mobile phones facilitated continued supervision. 7) Actions taken to maintain supplies included creating parallel supply chains, providing buffer stocks to CHWs, and storing commodities in decentralized locations. 8) When travel was restricted, reporting and data collection were continued using mobile phones and use of local data collectors. 9) CHWs and supervisors faced security threats and psychological trauma as a result of their work. Conclusions To achieve impact, policy makers and program implementers will have to address the bottlenecks to CHW service delivery common in stable low-income settings as well as the additional challenges unique to humanitarian settings. Future interventions should take into account the lessons learned from years of experience with implementation of community-based primary health care in humanitarian settings. There is also a need for rigorous assessments of community-based primary health care interventions in humanitarian settings.
Collapse
Affiliation(s)
- Nathan P Miller
- UNICEF, New York, USA.,Columbia University Mailman School of Public Health, New York, USA
| | | | | | | | | |
Collapse
|
12
|
Miller NP, Zunong N, Al-Sorouri TAA, Alqadasi YM, Ashraf S, Siameja C. Implementing integrated community case management during conflict in Yemen. J Glob Health 2021; 10:020601. [PMID: 33110596 PMCID: PMC7568935 DOI: 10.7189/jogh.10.020601] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The conflict in Yemen has devastated the health system, with only 51% of health facilities classified as fully functional and 19.7 million people lacking access to health care. To address the urgent need for primary health care services in rural communities, Save the Children launched an iCCM program in Lahj and Taiz Governorates. A qualitative study was conducted to document the challenges to iCCM service delivery and to aid in developing strategies for overcoming service delivery bottlenecks in conflict-affected rural areas. Methods Qualitative data were collected in Aden City, Lahj Governorate, and Taiz Governorate. Twenty-three IDIs and six FGDs were conducted with iCCM stakeholders at all levels. Results Key findings included: 1) Policy, coordination, and funding were challenged by the fact that iCCM was not integrated into the national health system and was implemented as a short-term emergency program. 2) Villages that received services from a CHW who was based in a different community experienced reduced access to services, especially during times of heightened conflict and insecurity, when CHWs could not travel. 3) Supervision, supply chain, and monitoring were all challenges that were exacerbated by difficulties in travel due to the conflict. Potential solutions to these included the use of mobile technology for supervision and data collection and pre-positioning of buffer stocks in locations closer to CHWs. 4) Travel was seen as the primary threat to the safety of CHWs and supervisors. Measures taken to reduce the risk included limiting travel during periods of heightened insecurity, safety training for CHWs, and use of mobile technology for communication. Conclusions CHWs were able to provide iCCM services in a challenging and insecure context. The challenges in delivery of services were related to both a weak health system and the conflict. Several adaptations to service delivery to overcome the bottlenecks have been identified and should be considered for future community health programs. The closure of the program in Taiz after only 14 months of implementation is a stark illustration of the failure of the current model of short-term humanitarian funding to address long-term needs in protracted emergencies.
Collapse
Affiliation(s)
- Nathan P Miller
- UNICEF, New York, New York, USA.,Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | | | | | | | | |
Collapse
|
13
|
Studying Executive Directors and Supervisors Views of Organizational and Policy-Level Challenges Faced by Community Health Workers. J Ambul Care Manage 2021; 44:250-263. [PMID: 34120125 DOI: 10.1097/jac.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Within the United States, there is an absence of a national community health worker (CHW) program. There is substantial regional and state-based variability in the population served by CHWs, their disease focus, and availability of training, supervision, and other supports. This article seeks to respond to the call in the literature to work collaboratively with CHW professional associations to identify, reflect, and respond to CHW workforce development and sustainability issues. We partnered with 8 member organizations of the Association of Perinatal Networks of New York and conducted 2 focus groups with 7 executive directors and 6 supervisors. Data were analyzed using thematic analysis. Policy barriers included funding, accessibility of evidence-based practices, and credentialing. Organizational barriers included recruitment and high turnover and interorganizational referral processes and management. This study offers recommendations for supports needed to sustain CHWs, with an emphasis on greater investment in recruitment and training, higher compensation, and interorganizational collaboration.
Collapse
|
14
|
Diagnostic performance of a Recombinant Polymerase Amplification Test-Lateral Flow (RPA-LF) for cutaneous leishmaniasis in an endemic setting of Colombia. PLoS Negl Trop Dis 2021; 15:e0009291. [PMID: 33909619 PMCID: PMC8081229 DOI: 10.1371/journal.pntd.0009291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Control of cutaneous leishmaniasis by public health systems in the Americas relies on case identification and treatment. Point-of-care diagnostics that can be performed by health workers within or near affected communities could effectively bring the health system to the resource-limited sites providing early diagnosis and treatment, reducing morbidity and the burden of disease. Methodology/principal findings A cross-sectional study was undertaken to evaluate the diagnostic test performance of Isothermal Recombinase Polymerase Amplification (RPA) targeting Leishmania kinetoplast DNA, coupled with a lateral flow (LF) immunochromatographic strip, in a field setting and a laboratory reference center. Minimally invasive swab and FTA filter paper samples were obtained by community health workers and highly trained technicians from ulcerated lesions of > 2 weeks’ evolution from 118 patients’ ≥ 2 years of age in the municipality of Tumaco, Nariño. Extracted DNA was processed by RPA-LF at a reference center or in a primary health facility in the field. Evaluation was based on a composite “gold standard” that included microscopy, culture, biopsy and real-time polymerase chain reaction detection of Leishmania 18S rDNA. Standard of care routine diagnostic tests were explored as comparators. Sensitivity and specificity of RPA-LF in the reference lab scenario were 87% (95%CI 74–94) and 86% (95%CI 74–97), respectively. In the field scenario, the sensitivity was 75% (95%CI 65–84) and specificity 89% (95%CI 78–99). Positive likelihood ratios in both scenarios were higher than 6 while negative likelihood ratios ranged to 0.2–0.3 supporting the usefulness of RPA-LF to rule-in and potentially to rule-out infection. Conclusions/significance The low complexity requirements of RPA-LF combined with non-invasive sampling support the feasibility of its utilization by community health workers with the goal of strengthening the diagnostic capacity for cutaneous leishmaniasis in Colombia. Trial registration ClinicalTrials.gov NCT04500873. Limited access to diagnosis is a critical determinant of the “neglect” that defines the so-called Neglected Tropical Diseases (NTDs) including cutaneous leishmaniasis. Diagnostic tests that can be performed close to and involve the participation of the affected communities would improve access to treatment as well as diagnosis. Using non-invasive swab and filter paper samples obtained by Community Health Workers, we evaluated the diagnostic performance of an innovative and technically simple molecular test: Isothermal Recombinase Polymerase Amplification (RPA) to detect Leishmania DNA, coupled with a lateral flow (LF) strip to read the results with the naked eye. The RPA-LF test demonstrated high sensitivity and specificity and capacity to rule in or rule out a diagnosis of cutaneous leishmaniasis in both an endemic field setting and reference laboratory. The findings encourage the further optimization of the test format for Point-of-Care diagnosis by health personnel and rural health workers in endemic settings.
Collapse
|
15
|
Galjour J, Havik P, Aaby P, Rodrigues A, Mpinga EK. Chronic Political Instability and the HIV/AIDS Response in Guinea-Bissau from 2000 to 2015: A Systematic Review. Trop Med Infect Dis 2021; 6:36. [PMID: 33809655 PMCID: PMC8005934 DOI: 10.3390/tropicalmed6010036] [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: 01/07/2021] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Guinea-Bissau suffers from political instability and an unusually high HIV/AIDS burden compared to other countries in the West Africa region. We conducted a systematic review on the HIV/AIDS epidemic in Guinea-Bissau during the Millennium Development Goals (MDGs) period (2000-2015), which dovetailed with a period of chronic political instability in the country's history. We searched published works on the HIV/AIDS epidemic in Guinea-Bissau for references to chronic political instability. Six databases and the grey literature were searched, informed by expert opinion and manual research through reference tracing. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search yielded 122 articles about HIV/AIDS in Guinea-Bissau during the MDG years. Biomedical, clinical, or epidemiological research predominated public health research production on HIV/AIDS in Guinea-Bissau in this period. Six articles addressing themes related to chronic political instability, including how political instability has affected the HIV/AIDS disease response, were identified. The results suggest the importance of considering a broader political epidemiology that accounts for socio-political aspects such as governance, human rights, and community responses into which any national HIV/AIDS response is integrated.
Collapse
Affiliation(s)
- Joshua Galjour
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland;
| | - Philip Havik
- Centre for Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, Universidade NOVA de Lisboa, 1349-008 Lisbon, Portugal;
| | - Peter Aaby
- Bandim Health Project, Apartado 8611004, Bissau Codex, Guinea-Bissau; (P.A.); (A.R.)
| | - Amabelia Rodrigues
- Bandim Health Project, Apartado 8611004, Bissau Codex, Guinea-Bissau; (P.A.); (A.R.)
| | | |
Collapse
|
16
|
Miller NP, Richards AK, Marx MA, Checchi F, Kozuki N. Assessing community health worker service delivery in humanitarian settings. J Glob Health 2021; 10:010307. [PMID: 32257135 PMCID: PMC7100867 DOI: 10.7189/jogh.10.010307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Nathan P Miller
- UNICEF, New York, New York, USA.,Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adam K Richards
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, USA
| | - Melissa A Marx
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Francesco Checchi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Naoko Kozuki
- Research, Evaluation, and Learning Unit, International Rescue Committee, Washington, D.C., USA
| |
Collapse
|
17
|
Munyuzangabo M, Gaffey MF, Khalifa DS, Als D, Ataullahjan A, Kamali M, Jain RP, Meteke S, Radhakrishnan A, Shah S, Siddiqui FJ, Bhutta ZA. Delivering maternal and neonatal health interventions in conflict settings: a systematic review. BMJ Glob Health 2021; 5:e003750. [PMID: 33608264 PMCID: PMC7903125 DOI: 10.1136/bmjgh-2020-003750] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While much progress was made throughout the Millennium Development Goals era in reducing maternal and neonatal mortality, both remain unacceptably high, especially in areas affected by humanitarian crises. While valuable guidance on interventions to improve maternal and neonatal health in both non-crisis and crisis settings exists, guidance on how best to deliver these interventions in crisis settings, and especially in conflict settings, is still limited. This systematic review aimed to synthesise the available literature on the delivery on maternal and neonatal health interventions in conflict settings. METHODS We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and maternal and neonatal health. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries and describing a maternal or neonatal health intervention delivered during or within 5 years after the end of a conflict were included. Information on population, intervention, and delivery characteristics were extracted and narratively synthesised. Quantitative data on intervention coverage and effectiveness were tabulated but no meta-analysis was undertaken. RESULTS 115 publications met our eligibility criteria. Intervention delivery was most frequently reported in the sub-Saharan Africa region, and most publications focused on displaced populations based in camps. Reported maternal interventions targeted antenatal, obstetric and postnatal care; neonatal interventions focused mostly on essential newborn care. Most interventions were delivered in hospitals and clinics, by doctors and nurses, and were mostly delivered through non-governmental organisations or the existing healthcare system. Delivery barriers included insecurity, lack of resources and lack of skilled health staff. Multi-stakeholder collaboration, the introduction of new technology or systems innovations, and staff training were delivery facilitators. Reporting of intervention coverage or effectiveness data was limited. DISCUSSION The relevant existing literature focuses mostly on maternal health especially around the antenatal period. There is still limited literature on postnatal care in conflict settings and even less on newborn care. In crisis settings, as much as in non-crisis settings, there is a need to focus on the first day of birth for both maternal and neonatal health. There is also a need to do more research on how best to involve community members in the delivery of maternal and neonatal health interventions. PROSPERO REGISTRATION NUMBER CRD42019125221.
Collapse
Affiliation(s)
- Mariella Munyuzangabo
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dina S Khalifa
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
18
|
Ratnayake R, Tammaro M, Tiffany A, Kongelf A, Polonsky JA, McClelland A. People-centred surveillance: a narrative review of community-based surveillance among crisis-affected populations. Lancet Planet Health 2020; 4:e483-e495. [PMID: 33038321 PMCID: PMC7542093 DOI: 10.1016/s2542-5196(20)30221-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
Outbreaks of disease in settings affected by crises grow rapidly due to late detection and weakened public health systems. Where surveillance is underfunctioning, community-based surveillance can contribute to rapid outbreak detection and response, a core capacity of the International Health Regulations. We reviewed articles describing the potential for community-based surveillance to detect diseases of epidemic potential, outbreaks, and mortality among populations affected by crises. Surveillance objectives have included the early warning of outbreaks, active case finding during outbreaks, case finding for eradication programmes, and mortality surveillance. Community-based surveillance can provide sensitive and timely detection, identify valid signals for diseases with salient symptoms, and provide continuity in remote areas during cycles of insecurity. Effectiveness appears to be mediated by operational requirements for continuous supervision of large community networks, verification of a large number of signals, and integration of community-based surveillance within the routine investigation and response infrastructure. Similar to all community health systems, community-based surveillance requires simple design, reliable supervision, and early and routine monitoring and evaluation to ensure data validity. Research priorities include the evaluation of syndromic case definitions, electronic data collection for community members, sentinel site designs, and statistical techniques to counterbalance false positive signals.
Collapse
Affiliation(s)
- Ruwan Ratnayake
- International Rescue Committee, New York, NY, USA; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Meghan Tammaro
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jonathan A Polonsky
- World Health Organization, Geneva, Switzerland; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Amanda McClelland
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| |
Collapse
|
19
|
Falciparum Malaria in Febrile Patients at Sentinel Sites for Influenza Surveillance in the Central African Republic from 2015 to 2018. Interdiscip Perspect Infect Dis 2020; 2020:3938541. [PMID: 32802053 PMCID: PMC7403902 DOI: 10.1155/2020/3938541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/09/2020] [Accepted: 07/01/2020] [Indexed: 12/03/2022] Open
Abstract
Malaria is a major public health issue in the Central African Republic (CAR) despite massive scale-up of malaria interventions. However, no information is available on the incidence of malaria in febrile illness cases or on the distribution of malaria infection according to demographic characteristics, which are important indicators and valuable epidemiological surveillance tools. This study therefore aimed to characterize malaria in the network of sentinel sites set up for influenza surveillance. A retrospective analysis was conducted to explore the data from these sentinel sites from 2015 to 2018. The Paracheck-Pf® rapid diagnosis test kit was used to screen for malaria in febrile illness cases. A total of 3609 malaria cases were identified in 5397 febrile patients, giving an incidence rate of 66.8%. The age group of 1–4 years was the most affected by malaria (76.0%). Moreover, prevalence varied across different sentinel sites, with the Bossembele Health Center, located in a rural area, showing an incidence of 96%, the Saint Joseph Health Center in a semiurban area of Bangui showing an incidence of 75%, and the Bangui Pediatric Complex in an urban site with an incidence of only 44.6%. Malaria transmission was holoendemic over the four-year study period, and malaria incidence decreased from 2016 to 2018. The incidence of malaria coinfection with influenza was 6.8%. This study demonstrated clear microspatial heterogeneity of malaria. Malaria was consistently the most frequent cause of febrile illness. Including sites in different climate zones in the CAR will allow for a more representative study.
Collapse
|
20
|
Masefield SC, Megaw A, Barlow M, White PCL, Altink H, Grugel J. Repurposing NGO data for better research outcomes: a scoping review of the use and secondary analysis of NGO data in health policy and systems research. Health Res Policy Syst 2020; 18:63. [PMID: 32513183 PMCID: PMC7278191 DOI: 10.1186/s12961-020-00577-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Non-governmental organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas, including the evaluation of health policy and programmes. Methods A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytical approach provided a comprehensive overview and descriptive analyses of the studies that (1) used data produced or collected by or about NGOs; (2) performed secondary analysis of the NGO data (beyond the use of an NGO report as a supporting reference); and (3) analysed NGO-collected clinical data. Results Of the 156 studies that performed secondary analysis of NGO-produced or collected data, 64% (n = 100) used NGO-produced reports (mostly to a limited extent, as a contextual reference or to critique NGO activities) and 8% (n = 13) analysed NGO-collected clinical data. Of these studies, 55% (n = 86) investigated service delivery research topics and 48% (n = 51) were undertaken in developing countries and 17% (n = 27) in both developing and developed countries. NGOs were authors or co-authors of 26% of the studies. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), albeit with some limitations such as inconsistent and missing data. Conclusion We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics such as conflict-affected areas. NGO–academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. The use of NGO data use could enable relevant and timely research in the areas of programme evaluation and health policy and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries.
Collapse
Affiliation(s)
- Sarah C Masefield
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom. .,Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.
| | - Alice Megaw
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom
| | - Matt Barlow
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
| | - Piran C L White
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Environment and Geography, University of York, York, YO10 5NG, United Kingdom
| | - Henrice Altink
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of History, University of York, York, YO10 5NH, United Kingdom
| | - Jean Grugel
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
| |
Collapse
|
21
|
Ramos Jaraba SM, Quiceno Toro N, Ochoa Sierra M, Ruiz Sánchez L, García Jiménez MA, Salazar-Barrientos MY, Bedoya Bedoya E, Vélez Álvarez GA, Langer A, Gausman J, Garcés-Palacio IC. Health in conflict and post-conflict settings: reproductive, maternal and child health in Colombia. Confl Health 2020; 14:33. [PMID: 32514298 PMCID: PMC7254675 DOI: 10.1186/s13031-020-00273-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 04/14/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. OBJECTIVE To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. METHODS Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. RESULTS All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the post-conflict context. CONCLUSIONS In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.
Collapse
Affiliation(s)
- Sara Milena Ramos Jaraba
- Grupo de Epidemiologia, Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| | - Natalia Quiceno Toro
- Grupo Cultura, Violencia y Territorio, Instituto de Estudios Regionales, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| | - María Ochoa Sierra
- Hegemonía, Guerras y Conflictos, Instituto de Estudios Políticos, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| | - Laura Ruiz Sánchez
- Facultad de ciencias sociales y humanas, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| | - Marlly Andrea García Jiménez
- Grupo Cultura, Violencia y Territorio, Instituto de Estudios Regionales, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| | - Mary Y. Salazar-Barrientos
- Nacer Salud Sexual Reproductiva, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| | - Edison Bedoya Bedoya
- Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| | - Gladis Adriana Vélez Álvarez
- Nacer Salud Sexual Reproductiva, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| | - Ana Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB Building 7th Floor, Boston, USA
| | - Jewel Gausman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB Building 7th Floor, Boston, USA
| | - Isabel C. Garcés-Palacio
- Grupo de Epidemiologia, Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Calle 70 No. 52-72, Medellín, Colombia
| |
Collapse
|
22
|
Meteke S, Stefopulos M, Als D, Gaffey M, Kamali M, Siddiqui FJ, Munyuzangabo M, Jain RP, Shah S, Radhakrishnan A, Ataullahjan A, Bhutta ZA. Delivering infectious disease interventions to women and children in conflict settings: a systematic reviefw. BMJ Glob Health 2020; 5:e001967. [PMID: 32341087 PMCID: PMC7213813 DOI: 10.1136/bmjgh-2019-001967] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/19/2020] [Accepted: 03/07/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Conflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents. METHODS We searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery site and personnel involved, as well as barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data. RESULTS A majority of the 194 eligible publications reported on intervention delivery in sub-Saharan Africa. Vaccines for measles and polio were the most commonly reported interventions, followed by malaria treatment. Over two-thirds of reported interventions were delivered in camp settings for displaced families. The use of clinics as a delivery site was reported across all intervention types, but outreach and community-based delivery were also reported for many interventions. Key barriers to service delivery included restricted access to target populations; conversely, adopting social mobilisation strategies and collaborating with community figures were reported as facilitating intervention delivery. Few publications reported on intervention coverage, mostly reporting variable coverage for vaccines, and fewer reported on intervention effectiveness, mostly for malaria treatment regimens. CONCLUSIONS Despite an increased focus on health outcomes in humanitarian crises, our review highlights important gaps in the literature on intervention delivery among specific subpopulations and geographies. This indicates a need for more rigorous research and reporting on effective strategies for delivering infectious disease interventions in different conflict contexts. PROSPERO REGISTRATION NUMBER CRD42019125221.
Collapse
Affiliation(s)
- Sarah Meteke
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marianne Stefopulos
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Health System and Services Research, Duke-NUS Medical School, Singapore
| | - Mariella Munyuzangabo
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
23
|
Ferdinand DY, Nadlaou B, Samuel N, Oscar BY, Raphael M, Christophe N, Lopes S, Allan R. Evaluation of the effectiveness of community health workers in the fight against malaria in the Central African Republic (2012-2017). Trans R Soc Trop Med Hyg 2020; 114:173-184. [PMID: 31687768 DOI: 10.1093/trstmh/trz104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 08/18/2019] [Accepted: 09/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This last decade's ongoing conflict in the Central African Republic (CAR) has led to gradual and continuous destruction of health services. With severe gaps in qualified health professionals, community health workers (CHWs) have become essential to ensuring health care access to the affected population. This article aims to evaluate the effectiveness of a 10-y CHW program in the CAR. METHODS Routine case management data from CHWs were collected in the Paoua district from January 2012 to December 2017 and analysed. Structured interviews were conducted in the Paoua and Carnot health districts among individuals from three different groups (health service beneficiaries, CHWs and health facility managers). RESULTS From 2012 to 2017, 353 948 people consulted for malaria suspicion with CHWs and 86% were found to be malaria positive after a rapid diagnostic test. Among those diagnosed patients, 98.5% received adequate treatment and nearly 1.5% were referred to health facilities. Also, 94.5% of respondents identified fever as the major malaria symptom. About 70% of the population could identify three malaria signs/symptoms and 84.4% accepted and used CHW services. Interviews with CHWs revealed that 45.8% of them received at least four training sessions per month as part of their capacity building. CONCLUSIONS CHWs can be a resourceful solution when other health professional are scarce. This study showed that CHWs are not only able to deliver curative and preventive health services, but they are also well accepted by the served communities.
Collapse
Affiliation(s)
| | | | - Nzalapan Samuel
- National Malaria Control Program, Bangui, Central African Republic
| | | | - Mbailao Raphael
- National Malaria Control Program, Bangui, Central African Republic
| | - Ndoua Christophe
- National Malaria Control Program, Bangui, Central African Republic
| | | | | |
Collapse
|
24
|
Gordon A, Vander Meulen RJ, Maglior A. The 2019 Isdell:Flowers Cross Border Malaria Initiative Round Table: community engagement in the context of malaria elimination. Malar J 2019; 18:432. [PMID: 31856833 PMCID: PMC6924078 DOI: 10.1186/s12936-019-3054-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/07/2019] [Indexed: 11/10/2022] Open
Abstract
Government officials, representatives from malaria endemic communities, and nonprofit, academic, and private sector partners convened at the 2019 Isdell:Flowers Cross Border Malaria Initiative Round Table in Livingstone, Zambia from February 28-March 1, 2019 to discuss the necessity of community engagement and the involvement of those directly affected by malaria in malaria elimination efforts. Participants shared practical examples and principles of successful community engagement over the course of the Round Table. Three core principles of effective community engagement emerged: (1) there is no "one size fits all" community engagement strategy, (2) community engagement must be a bidirectional activity, and (3) community members must be at the heart of malaria elimination efforts.
Collapse
Affiliation(s)
- Alexandra Gordon
- Isdell:Flowers Cross Border Malaria Initiative, J.C. Flowers Foundation, New York, NY, USA.
| | | | - Alysse Maglior
- Isdell:Flowers Cross Border Malaria Initiative, J.C. Flowers Foundation, New York, NY, USA
| |
Collapse
|
25
|
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
| | | |
Collapse
|
26
|
Boyce MR, Katz R. Community Health Workers and Pandemic Preparedness: Current and Prospective Roles. Front Public Health 2019; 7:62. [PMID: 30972316 PMCID: PMC6443984 DOI: 10.3389/fpubh.2019.00062] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/04/2019] [Indexed: 01/24/2023] Open
Abstract
Despite the importance of community health workers (CHWs) to health systems in resource-constrained environments, relatively little has been written about their contributions to pandemic preparedness. In this perspective piece, we draw from the response to the 2014 Ebola and 2015 Zika epidemics to review examples whereby CHWs contributed to health security and pandemic preparedness. CHWs promoted pandemic preparedness prior to the epidemics by increasing the access to health services and products within communities, communicating health concepts in a culturally appropriate fashion, and reducing the burdens felt by formal healthcare systems. During the epidemics, CHWs promoted pandemic preparedness by acting as community-level educators and mobilizers, contributing to surveillance systems, and filling health service gaps. Acknowledging the success CHWs have had in these roles and in previous interventions, we propose that the cadre may be better engaged in pandemic preparedness in the future. Some practical strategies for achieving this include training and using CHWs to communicate One Health information to at-risk communities prior to outbreaks, pooling them into a reserve health corps to be used during public health emergencies, and formalizing agreements and strategies to promote the early engagement of CHWs in response actions. Recognizing that CHWs already play a role in pandemic preparedness, we feel that expanding the roles and responsibilities of CHWs represents a practical means of improving pandemic and community-level resilience.
Collapse
Affiliation(s)
- Matthew R Boyce
- Center for Global Health Science & Security, Georgetown University, Washington, DC, United States
| | - Rebecca Katz
- Center for Global Health Science & Security, Georgetown University, Washington, DC, United States
| |
Collapse
|