1
|
Masaku J, Gachohi JM, Sinkeet A, Maghanga M, Wakesho F, Omondi W, Monnier N, Steinmann P, Reigl LS, Lange IL, Winkler AS, Njenga SM, Amuyunzu-Nyamongo M. Community preferred drug delivery approaches for pilot roll-out of a potential novel paediatric schistosomiasis treatment option in two endemic counties of Kenya: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003221. [PMID: 38820456 PMCID: PMC11142487 DOI: 10.1371/journal.pgph.0003221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/22/2024] [Indexed: 06/02/2024]
Abstract
Treating preschool age children (PSAC) for schistosomiasis has remained a challenge due to lack of a pediatric formulation. In response to this unmet need, the Paediatric Praziquantel Consortium has developed a potential novel paediatric treatment option. In advance to its roll-out to follow regulatory response, we conducted a social science study to gather information on preferred drug delivery approaches to inform implementation. A cross-sectional study was conducted in eight villages in two purposively selected Kenyan counties. A questionnaire was administered on 690 parents/guardians of PSAC at household level. Preferred drug delivery approaches were analyzed using frequencies and proportions. We conducted key informant interviews with 17 opinion leaders and 28 healthcare workers, and 12 focus group discussions with parents/guardians of PSAC and 7 with community health volunteers (CHVs). Thematic analysis was performed on the qualitative data. Majority of the 690 respondents were women 594 (86.1%) with a mean age of 34.1 (SD = 11.3, min-max = 18-86). Community-based mass drug administration (cMDA) was the most preferred drug delivery method by 598 participants (86.7%), followed by health facility/fixed points by 398 participants (57.7%). Similarly, in the qualitative data participants indicated they prefer cMDA since the CHVs who would distribute the medication are familiar with households with PSAC and are trusted to explain the drug effects. Health facilities/fixed points were the second most preferred drug delivery approach, but some health workers we interviewed expressed concern about potential understaffing and overcrowding of facilities. Appropriate timing of the drug distribution, not to interfere with farming activities, was considered critical, irrespective of the approach used. All profiles of study participants preferred cMDA over the other delivery approaches due to the convenience of receiving drugs at home and providing explanations about the new drug. For positive outcomes, adequate planning, proper timings and community involvement are highly recommended.
Collapse
Affiliation(s)
- Janet Masaku
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - John M. Gachohi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - Alice Sinkeet
- African Institute for Health and Development (AIHD), Nairobi, Kenya
| | - Mary Maghanga
- African Institute for Health and Development (AIHD), Nairobi, Kenya
| | - Florence Wakesho
- Division of Vector Borne and Neglected Tropical Diseases (DVB/NTDs), Ministry of Health (MoH), Nairobi, Kenya
| | - Wyckliff Omondi
- Division of Vector Borne and Neglected Tropical Diseases (DVB/NTDs), Ministry of Health (MoH), Nairobi, Kenya
| | - Nora Monnier
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Peter Steinmann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lisa Sophie Reigl
- Department of Neurology, Center for Global Health, Technical University of Munich (TUM), Munich, Germany
| | - Isabelle L. Lange
- Department of Neurology, Center for Global Health, Technical University of Munich (TUM), Munich, Germany
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, Technical University of Munich (TUM), Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sammy M. Njenga
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Mary Amuyunzu-Nyamongo
- Division of Vector Borne and Neglected Tropical Diseases (DVB/NTDs), Ministry of Health (MoH), Nairobi, Kenya
| |
Collapse
|
2
|
Arney JK, Headland MK, Bertone AM, Meite A, Ettiegne-Traore V, Asemanyi-Mensah K, Dede Teiko Dzathor I, Kargbo-Labour I, Jalloh U, Houck P, Stukel D. Synthesis of findings from the literature and a qualitative research study on the impacts of gender, disability, and ethnicity in Neglected Tropical Diseases programs. PLoS Negl Trop Dis 2023; 17:e0011782. [PMID: 38048347 PMCID: PMC10721307 DOI: 10.1371/journal.pntd.0011782] [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: 05/25/2023] [Revised: 12/14/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION Act to End NTDs | West, a USAID-funded program that supports national governments to eliminate or control five neglected tropical diseases (NTDs) in West Africa including trachoma, lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminthiasis, conducted a gender and social inclusion analysis to determine how NTDs differentially impact various populations and how gender and social norms impact NTD programs to inform future programming. METHODS The study used a mixed methods approach including a literature review; primary qualitative data collection; and monitoring data in Côte d'Ivoire, Sierra Leone, and Ghana. RESULTS Women and girls face additional health risks from many NTDs compared to men and boys. In addition to differential health burden, the social and economic impacts of NTD-related disability or infertility can be particularly dire for women and girls. Men were somewhat less likely to participate in mass drug administration (MDAs) due to: lack of information about campaigns, lack of access due to work, and higher levels of mistrust of the government and concerns about side effects of the medicines. Pregnant and breastfeeding women were sometimes excluded by community drug distributors (CDDs) from certain types of MDAs for which they are eligible. Training participation rates for CDDs and supervisors were nearly universally higher for men than women, even though feedback on the effectiveness of female CDDs was overwhelmingly positive, and female CDDs often have more access to other women in conservative households. The role of a CDD can lead to career and social opportunities for women. However, challenges faced by CDDs were seen as a greater barrier for women, including transportation, safety, household responsibilities, lower education levels, and low or lack of wages. DISCUSSION Programs to address NTDs can promote equity and improve programming by increasing women's participation as CDDs and providing financial compensation. Additionally, programs should prioritize inclusive training for CDDs, and inclusive messaging about MDA for communities.
Collapse
Affiliation(s)
| | | | | | - Aboulaye Meite
- Programme National de Lutte Contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministry of Health, Abidjan, Côte d’Ivoire
| | | | - Kofi Asemanyi-Mensah
- Neglected Tropical Diseases Programme, Disease Control and Prevention Department, Ghana Health Service, Public Health Division, Accra, Ghana
| | | | - Ibrahim Kargbo-Labour
- Neglected Tropical Disease Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Umu Jalloh
- Helen Keller International, Freetown, Sierra Leone
| | - Patricia Houck
- Helen Keller International, NYC, New York, United States of America
| | - Diana Stukel
- FHI 360, Washington, DC, United States of America
| |
Collapse
|
3
|
Clark J, Davis EL, Prada JM, Gass K, Krentel A, Hollingsworth TD. How correlations between treatment access and surveillance inclusion impact neglected tropical disease monitoring and evaluation-A simulated study. PLoS Negl Trop Dis 2023; 17:e0011582. [PMID: 37672518 PMCID: PMC10506705 DOI: 10.1371/journal.pntd.0011582] [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: 09/08/2022] [Revised: 09/18/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Neglected tropical diseases (NTDs) largely impact marginalised communities living in tropical and subtropical regions. Mass drug administration is the leading intervention method for five NTDs; however, it is known that there is lack of access to treatment for some populations and demographic groups. It is also likely that those individuals without access to treatment are excluded from surveillance. It is important to consider the impacts of this on the overall success, and monitoring and evaluation (M&E) of intervention programmes. We use a detailed individual-based model of the infection dynamics of lymphatic filariasis to investigate the impact of excluded, untreated, and therefore unobserved groups on the true versus observed infection dynamics and subsequent intervention success. We simulate surveillance in four groups-the whole population eligible to receive treatment, the whole eligible population with access to treatment, the TAS focus of six- and seven-year-olds, and finally in >20-year-olds. We show that the surveillance group under observation has a significant impact on perceived dynamics. Exclusion to treatment and surveillance negatively impacts the probability of reaching public health goals, though in populations that do reach these goals there are no signals to indicate excluded groups. Increasingly restricted surveillance groups over-estimate the efficacy of MDA. The presence of non-treated groups cannot be inferred when surveillance is only occurring in the group receiving treatment.
Collapse
Affiliation(s)
- Jessica Clark
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, Scotland
- Big Data Institute, Neglected Tropical Disease Modelling Consortium, University of Oxford, Oxford, England
| | - Emma L. Davis
- Big Data Institute, Neglected Tropical Disease Modelling Consortium, University of Oxford, Oxford, England
| | - Joaquin M. Prada
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, England
| | - Katherine Gass
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | - T. Déirdre Hollingsworth
- Big Data Institute, Neglected Tropical Disease Modelling Consortium, University of Oxford, Oxford, England
| |
Collapse
|
4
|
Arjyal A, Parajuli A, Kharel C, Del Barrio MO, Baral SC. Understanding gender and its intersection with social stratifiers on prevention and care seeking behavior of lymphatic filariasis in Nepal. Infect Dis Poverty 2023; 12:77. [PMID: 37608332 PMCID: PMC10463999 DOI: 10.1186/s40249-023-01126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a debilitating and painful neglected tropical disease and is one of the leading causes of permanent disability. In many countries, the intersection of gender with various social stratifiers has influenced exposure to LF and ultimately impacting the disease burden and its elimination. This study aimed to explore the influence of gender and its intersection with other social stratifiers for the prevention and care seeking behavior of LF in Nepal. METHODS This study employed qualitative research methods: in-depth interviews (IDIs) and focus group discussions (FGDs) for data collection in Bardiya, Nepal. A total of 22 IDIs (11 male, 11 female) and 2 FGDs (1 male and 1 female) were conducted with the community people between January and March 2020. The participants were purposively selected to represent different social stratifiers including age, sex, ethnicity, occupation. The data collected were analyzed using a thematic framework approach with use of intersectional gender analysis matrix. RESULTS The study findings revealed that men spend more time outside their household compared to women while fulfilling their roles and responsibilities, largely determined by societal expectations and gender norms. This resulted in limited access to preventive health services for men, as they often missed annual mass drug administration programme in their community and limited access to preventive methods. Further traditional occupation, specific to particular ethnicity, influenced the vulnerability to LF for certain ethnic groups. The ability to prevent exposure varied among individuals. Although women made decisions regarding the use of protective methods, it was influenced by patriarchal and gender norms. They often felt a responsibility to take care and priorities males and other family members when resources are limited. The intersectionality of gender with other social stratifiers such as marital status, ethnicity, and geographical areas influenced individual's ability to access information related to LF and care seeking. CONCLUSIONS Overall, the findings emphasized how access to resources, division of work, norms and values and decision-making power alone and its interaction with various social stratifiers shaped peoples' vulnerability to disease, ability to prevent exposure and response to illness.
Collapse
Affiliation(s)
| | | | - Chandani Kharel
- UNICEF, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Mariam Otmani Del Barrio
- UNICEF, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
5
|
Gruninger SK, Rasamoelina T, Rakotoarivelo RA, Razafindrakoto AR, Rasolojaona ZT, Rakotozafy RM, Soloniaina PR, Rakotozandrindrainy N, Rausche P, Doumbia CO, Jaeger A, Zerbo A, von Thien H, Klein P, van Dam G, Tannich E, Schwarz NG, Lorenz E, May J, Rakotozandrindrainy R, Fusco D. Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study. Infect Dis Poverty 2023; 12:44. [PMID: 37098581 PMCID: PMC10127445 DOI: 10.1186/s40249-023-01094-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: 12/19/2022] [Accepted: 04/09/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC. METHODS In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios. RESULTS The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection. CONCLUSIONS Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.
Collapse
Affiliation(s)
- Sarah Katharina Gruninger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | - Rivo Andry Rakotoarivelo
- Department of Infectious Diseases, University of Fianarantsoa Andrainjato, 301, Fianarantsoa, Madagascar
| | | | | | - Rodson Morin Rakotozafy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar
| | | | - Njary Rakotozandrindrainy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar
| | - Pia Rausche
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Cheick Oumar Doumbia
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- University Clinical Research Centre (UCRC), University of Sciences Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Anna Jaeger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Alexandre Zerbo
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Heidrun von Thien
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Philipp Klein
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Govert van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Egbert Tannich
- National Reference Centre for Tropical Pathogens (NRC), Hamburg, Germany
| | - Norbert Georg Schwarz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Department of Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Daniela Fusco
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.
| |
Collapse
|
6
|
Specht S, Keiser J. Helminth infections: Enabling the World Health Organization Road Map. Int J Parasitol 2022:S0020-7519(22)00180-1. [PMID: 36549443 DOI: 10.1016/j.ijpara.2022.10.006] [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: 07/22/2022] [Revised: 09/19/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
Helminthiases are considered among the most persistent public health problems. Control and/or elimination remains a global health challenge and the World Health Organization Road Map highlights critical gaps and actions required to reach the 2030 targets, among them the need for new and more effective treatment options. Stronger collaborations across different fields are required to reach these goals. The helminth elimination platform is one example of how knowledge of two different disease areas can be aligned to fuse expertise and break disease silos.
Collapse
Affiliation(s)
- Sabine Specht
- Drugs for Neglected Diseases Initiative, 15 Camille-Vidart, 1202 Geneva, Switzerland.
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland; University of Basel, P.O. Box, 4003, Basel, Switzerland
| |
Collapse
|
7
|
Abdul Halim AFN, Ahmad D, Miaw Yn JL, Masdor NA, Ramly N, Othman R, Kandayah T, Hassan MR, Dapari R. Factors Associated with the Acceptability of Mass Drug Administration for Filariasis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12971. [PMID: 36232271 PMCID: PMC9566436 DOI: 10.3390/ijerph191912971] [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: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Mass drug administration (MDA) has been implemented as a tool to eliminate lymphatic filariasis. Acceptability among susceptible populations is crucial to achieving MDA effective coverage. This systematic review aims to present and systematically determine the factors associated with the acceptability of MDA. Articles related to factors associated with acceptability were collected electronically from three different databases (Scopus, Web of Science, and PubMed). Four pairs of independent reviewers screened the titles and abstracts of the collected data, stored in EndnoteX7, against the inclusion criteria. Afterwards, the included articles have been critically appraised to assess the quality of the studies using the Mixed Method Appraisal Tool (MMAT). Of the 68 articles identified, 11 were included in the final review. Knowledge, awareness, attitude and perceptions, communications, delivery and accessibility of MDA, gender, and age are the factors associated with MDA acceptability. Community acceptance remains a challenge in the implementation of MDA. To expand MDA coverage in all endemic countries, there is a strong need to address the factors influencing community acceptance of MDA.
Collapse
Affiliation(s)
| | - Dzulfitree Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Jane Ling Miaw Yn
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Noor Azreen Masdor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nurfatehar Ramly
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Rahayu Othman
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Thinakaran Kandayah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Rahmat Dapari
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| |
Collapse
|
8
|
Mungall-Baldwin C. Women's participation in the prevention and control of dengue using environmental methods in the global south: a qualitative meta-synthesis. Int J Equity Health 2022; 21:140. [PMID: 36151547 PMCID: PMC9508726 DOI: 10.1186/s12939-022-01726-0] [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: 03/26/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dengue, a mosquito-borne viral disease, causes significant mortality and morbidity in low- to middle-income countries. A body of research indicates that women can be effective in implementing vector borne disease control, but they still face inequitable opportunities for participation, leadership and decision-making in the execution of dengue prevention and vector control programmes. Yet implementing informal environmental management practices to prevent mosquito vector breeding forms part of their domestic household responsibilities. Understanding the enablers and barriers to women’s equitable roles with men in formal and informal disease prevention, and the benefits of their participation could help to increase their role and may be a contributing factor to reducing disease rates. The objective of this qualitative meta-synthesis was to synthesise evidence about women’s roles in dengue prevention and control in the global south and generate insights around the barriers, enablers, and benefits. Methods Eight databases were searched from inception to 7th December 2020. One investigator independently reviewed all titles and abstracts for relevant articles. Grey literature was searched using 34 websites of global health and international development organisations. Results A total of 18 articles representing qualitative research or the qualitative component of mixed methods studies from Latin American and Caribbean (n = 8), Asia (n = 9), and one international review were included in the meta-synthesis. Relevant scholarship from Africa was lacking. This meta-synthesis revealed five unique themes surrounding women’s participation, seven categories of barriers, six of enablers, four health, well-being and social benefits for individuals, and four for communities . Conclusion An analysis of the results confirmed that women’s participation in dengue prevention was not gender equitable, gender sensitive nor transformative although women are the primary human resource for household and community-based prevention. Women demonstrated specific qualities aiding successful implementation. Corrective action is urgently needed to shift unhelpful gender norms, and empower women into leadership and decision-making roles.
Collapse
Affiliation(s)
- Cathy Mungall-Baldwin
- Institute of Health and Wellbeing, University of Glasgow, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland, UK. .,School of Public Health and Community Medicine, University of New South Wales, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| |
Collapse
|
9
|
Human rights as a framework for eliminating female genital schistosomiasis. PLoS Negl Trop Dis 2022; 16:e0010165. [PMID: 35239651 PMCID: PMC8893342 DOI: 10.1371/journal.pntd.0010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Female genital schistosomiasis (FGS) affects tens of millions of women and girls in sub-Saharan Africa, yet this inequitable threat is often overlooked by advocates in both the neglected tropical disease (NTD) and sexual and reproductive health and rights (SRHR) communities. FGS causes both acute infection and long-term sexual and reproductive health harm to marginalized women and girls, with gender, poverty, and rurality combining to invisibilize the disease. Human rights and gender imperatives can help to galvanize efforts to control and eliminate FGS, as they have for other NTDs. Specifically, international human rights obligations can frame state efforts to address FGS across healthcare settings, upstream social determinants of health, scientific research, and policy implementation. This article analyzes human rights–based approaches to FGS control and elimination efforts, outlining several areas for forward-looking reforms to health policy, programing, and practice. Building from the lessons learned in applying human rights–based approaches to advance progress on other NTDs, this analysis seeks to provide the NTD community with shared understanding around international legal obligations to engage SRHR advocates and draw heightened attention to FGS. Such human rights–based approaches to FGS control and elimination can help to reduce stigma and improve care for the millions of women and girls currently affected by this preventable disease. Female genital schistosomiasis (FGS) affects over 56 million women and girls in sub-Saharan Africa alone, yet this inequitable threat is largely ignored by global health advocates, program managers, and policymakers. The lack of international attention undermines efforts to eliminate schistosomiasis globally. International human rights law can help to reverse this neglect and shape the role of the international community in supporting elimination of FGS as a public health problem, as has been done for other neglected tropical diseases (NTDs). This analysis provides the NTD community with shared language around international legal obligations to engage sexual and reproductive health and rights (SRHR) advocates and draw attention to this often overlooked condition. Working together, these two communities can reduce stigma and improve the health and well-being of the millions of marginalized women and girls affected by this preventable disease.
Collapse
|
10
|
ul Hassan E, Kelly M, Waititu T, Olobio N, Kabona G, Mkocha H, Kivumbi P, Mwale C, Mubangizi A, Mugume F, Baayenda G, Mayeku R, Massangaie M, Mbofana MA, Cumaio M, Sisay A, Mersha T, Courtright P. OUP accepted manuscript. Int Health 2022; 14:i24-i28. [PMID: 35385863 PMCID: PMC8986360 DOI: 10.1093/inthealth/ihab086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Michaela Kelly
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BZ, UK
| | | | - Nicholas Olobio
- National Trachoma Project Manager, Federal Ministry of Health, Nigeria
| | - George Kabona
- Ministry of Health and Social Welfare, Dar es salaam, Tanzania
| | | | - Peter Kivumbi
- Sightsavers, Tanzania Office, Kinondoni District, Dar es Salaam
| | | | | | | | | | | | - Marilia Massangaie
- Department for Diseases Control and Prevention, National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Tolossa Mersha
- Neglected Tropical Disease Specialist, Oromia Regional Health Bureau, Finfinnee, Ethiopia
| | - Paul Courtright
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BZ, UK
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
11
|
Gender-related differences in prevalence, intensity and associated risk factors of Schistosoma infections in Africa: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009083. [PMID: 34788280 PMCID: PMC8635327 DOI: 10.1371/journal.pntd.0009083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 12/01/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schistosomiasis remains a global-health problem with over 90% of its burden concentrated in Africa. Field studies reflect the complex ways in which socio-cultural and socio-economic variables, affect the distribution of Schistosoma infections across different populations. This review set out to systematically investigate and quantify the differences in Schistosoma infection burdens between males and females in Africa for two of the most prevalent Schistosoma species-Schistosoma mansoni and Schistosoma haematobium. METHODOLOGY We searched (from inception to 11th March 2020) Embase, MEDLINE, PubMed, and Web of Science for relevant studies on schistosomiasis. We included studies that report S. mansoni and/or S. haematobium prevalence and/or intensity data distributed between males and females. We conducted meta-analyses on the male to female (M:F) prevalence of infection ratios. Subgroup analyses were performed according to study baseline prevalence, sample size and the lower and upper age limit of study participants. We also present a descriptive analysis of differential risk and intensity of infection across males and females. Evidence for differences in the prevalence of schistosomiasis infection between males and females is presented, stratified by Schistosoma species. RESULT We identified 128 relevant studies, with over 200,000 participants across 23 countries. Of all the reported differences in the prevalence of infection between males and females, only 41% and 34% were statistically significant for S. mansoni and S. haematobium, respectively. Similar proportions of studies (27% and 34% for for S. haematobium and S. mansoni, respectively) of the reported differences in intensity of infection between males and females were statistically significant. The meta-analyses summarized a higher prevalence of infection in males; pooled random-effects weighted M:F prevalence of infection ratios were 1.20 (95% CI 1.11-1.29) for S. haematobium and 1.15 (95% CI 1.08-1.22) for S. mansoni. However, females are underrespresented in some of the studies. Additionally, there was significant heterogeneity across studies (Higgins I2 statistic (p-values < 0.001, I2values>95%)). Results of the subgroup analysis showed that the baseline prevalence influenced the M:F prevalence ratios for S. haematobium and S. mansoni, with higher M:F prevalence of infection ratios in settings with a lower baseline prevalence of infection. Across the studies, we identified four major risk factors associated with infection rates: occupational and recreational water contact, knowledge, socio-economic factors and demographic factors. The effect of these risk factors on the burden of infection in males and females varied across studies. CONCLUSIONS We find evidence of differences in prevalence of infection between males and females which may reflect differences in gender norms and water contact activities, suggesting that policy changes at the regional level may help ameliorate gender-related disparities in schistosomiasis infection burden. Collecting, robustly analysing, and reporting, sex-disaggregated epidemiological data, is currently lacking, but would be highly informative for planning effective treatment programmes and establishing those most at risk of schistosomiasis infections.
Collapse
|
12
|
Christine Masong M, Ozano K, Tagne MS, Tchoffo MN, Ngang S, Thomson R, Theobald S, Tchuenté LAT, Kouokam E. Achieving equity in UHC interventions: who is left behind by neglected tropical disease programmes in Cameroon? Glob Health Action 2021; 14:1886457. [PMID: 33641612 PMCID: PMC7919912 DOI: 10.1080/16549716.2021.1886457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: The UN's Sustainable Development Goals (SDGs) which pledge to leave no one behind for Universal health coverage (UHC) raise the importance of ensuring equitable health outcomes and healthcare delivery. As Neglected Tropical Diseases (NTDs) affect the most disadvantaged and hard to reach populations, they are considered a litmus test for Universal health coverage.Objective: Here, we assess the challenges of implementing Mass Drug Administrations (MDAs) for schistosomiasis prevention and control, in a context of expanded treatment where both community and school-based distribution were carried out, assessing which groups are missed and developing strategies to enhance equity.Methods: This is a qualitative study applying ethnographic observations, in-depth interviews (109) and focus group discussions (6) with key informants and other community members. Participants included community drug distributors, teachers, health workers, and implementing partners across four schistosomiasis endemic regions in Cameroon. Data collected were analysed thematically.Results: Programme implementation gaps have created circumstances where indigenous farmers (originally from the region) and migrating farmers (not originally from the region known as 'strangers' and 'farm hands'), women of reproductive age and school-aged children are continuously missed in MDA efforts in Cameroon. Key implementation challenges that limit access to MDA within this context include inadequate sensitization campaigns that don't sufficiently build trust with different groups; limits in CDD training around pregnancy and reproductive health; lack of alignment between distribution and community availability and the exclusion of existing formal and informal governance structures that have established trusting community relationships.Conclusion: Through identifying key populations missed in MDAs within specific contexts, we highlight how social inclusion and equity could be increased within the Cameroonian context. A main recommendation is to strengthen trust at the community level and work with established partnerships and local governance structures that can support sustainable solutions for more equitable MDA campaigns.
Collapse
Affiliation(s)
- Makia Christine Masong
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marlene Siping Tagne
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Marlene Ntchinda Tchoffo
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Sharon Ngang
- Department of Sciences, Research Center for Schistosomiasis and Parasitology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Rachael Thomson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louis-Albert Tchuem Tchuenté
- Department of Sciences, Research Center for Schistosomiasis and Parasitology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Estelle Kouokam
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| |
Collapse
|
13
|
Fehr A, Nieto-Sanchez C, Muela J, Jaiteh F, Ceesay O, Maneh E, Baldeh D, Achan J, Dabira E, Conteh B, Bunders-Aelen J, Smekens T, Broekhuizen H, D'Alessandro U, Peeters Grietens K. From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia. Malar J 2021; 20:198. [PMID: 33902611 PMCID: PMC8073909 DOI: 10.1186/s12936-021-03732-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement—coverage, adherence, and compliance—that cast doubts about the actual and potential epidemiological impact of MDA on disease control and elimination. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. Methods This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA. Results 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. Conclusions This study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03732-z.
Collapse
Affiliation(s)
- Alexandra Fehr
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Claudia Nieto-Sanchez
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joan Muela
- Medical Anthropology Research Center, Universitat Rovira I Virgill, Tarragona, Spain
| | - Fatou Jaiteh
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Omar Ceesay
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ebrima Maneh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Dullo Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jane Achan
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Edgard Dabira
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bakary Conteh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Tom Smekens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D'Alessandro
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Koen Peeters Grietens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
14
|
The Impact of Neglected Tropical Diseases (NTDs) on Women's Health and Wellbeing in Sub-Saharan Africa (SSA): A Case Study of Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042180. [PMID: 33672237 PMCID: PMC7926948 DOI: 10.3390/ijerph18042180] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
Neglected Tropical Diseases (NTDs) trap individuals in a cycle of poverty through their devastating effects on health, wellbeing and social–economic capabilities that extend to other axes of inequity such as gender and/or ethnicity. Despite NTDs being regarded as equity tracers, little attention has been paid toward gender dynamics and relationships for gender-equitable access to NTD programs in sub-Saharan Africa (SSA). This paper examines the impact of NTDs on women’s health and wellbeing in SSA using Kenya as a case study. This research is part of a larger research program designed to examine the impact of NTDs on the health and wellbeing of populations in Kenya. Thematic analysis of key informants’ interviews (n = 21) and focus groups (n = 5) reveals first that NTDs disproportionately affect women and girls due to their assigned gender roles and responsibilities. Second, women face financial and time constraints when accessing health care due to diminished economic power and autonomy. Third, women suffer more from the related social consequences of NTDs (that is, stigma, discrimination and/or abandonment), which affects their health-seeking behavior. As such, we strongly suggest a gender lens when addressing NTD specific exposure, socio-economic inequities, and other gender dynamics that may hinder the successful delivery of NTD programs at the local and national levels.
Collapse
|
15
|
Torres-Vitolas CA, Dhanani N, Fleming FM. Factors affecting the uptake of preventive chemotherapy treatment for schistosomiasis in Sub-Saharan Africa: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009017. [PMID: 33465076 PMCID: PMC7846123 DOI: 10.1371/journal.pntd.0009017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/29/2021] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Schistosomiasis affects nearly 220 million people worldwide, mainly in Sub-Saharan Africa (SSA). Preventive chemotherapy (PC) treatment, through regular mass-drug administration (MDA) of Praziquantel tablets remains the control measure of choice by Ministries of Health. Current guidelines recommend that 75% of school-aged children receive treatment. Many programmes, however, struggle to achieve this target. Given the risk of high reinfection rates, attaining sustained high levels of treatment coverage is essential. This study provides a comprehensive review of the barriers and facilitators operating at different levels of analysis, from the individual to the policy level, conditioning the uptake of PC for schistosomiasis in SSA. Methodology/Principal findings A systematic literature search was conducted in several databases for publications released between January 2002 and 2019 that examined factors conditioning the uptake of Praziquantel in the context of MDA campaigns in SSA. A total of 2,258 unique abstracts were identified, of which 65 were selected for full text review and 30 met all eligibility criteria. Joanna Briggs Institute’s Critical Appraisal and the Mixed-Methods Assessment tools were used to assess the strength of the evidence. This review was registered with PROSPERO (CRD42017058525). A meta-synthesis approach was used. Results indicated publication bias, with the literature focusing on East African rural settings and evidence at the individual and programmatic levels. The main influencing factors identified included material wellbeing, drug properties, knowledge and attitudes towards schistosomiasis and MDAs, fears of side effects, gender values, community and health systems support, alongside programme design features, like training, sensitisation, and provision of incentives for drug-distributors. The effect of these factors on determining Praziquantel uptake were explored in detail. Conclusions/Significance Multiple determinants of treatment uptake were found in each level of analysis examined. Some of them interact with each other, thus affecting outcomes directly and indirectly. The promotion of context-based transdisciplinary research on the complex dynamics of treatment uptake is not only desirable, but essential, to design effective strategies to attain high levels of treatment coverage. Schistosomiasis is a parasitic infection that affects nearly 220 million people worldwide. Long-term effects include anaemia, growth stunting, bladder cancer and infertility. Currently, the main approach to schistosomiasis control involves mass preventive chemotherapy treatment. Current guidelines recommend treating 75% of school-aged children but many programmes struggle to achieve this target. This study conducted a comprehensive review of factors conditioning the uptake of treatment in Sub-Saharan Africa across different levels of analysis: individual, interpersonal, organisational, community and policy. This examination showed, first, that the literature suffers of publication bias, with most studies based in rural East African sites and focusing in discussing individual- and policy-level factors. It indicated as well that people’s livelihoods, food security, and school-enrolment, alongside knowledge and attitudinal factors influenced treatment uptake at the individual level. Various contextual factors concerning interpersonal relations, organisations’ resources, and prevalent socio-cultural features (e.g., gender) further shaped people’s responses to MDA campaigns. Finally, it was observed that the effectiveness of programme-level decisions on sensitisation, training, and drug-delivery strategies were constantly re-shaped by mediating factors operating at lower levels of analysis. We conclude that the promotion of context-based transdisciplinary research is essential to design effective strategies to promote sustainable high levels of treatment coverage.
Collapse
Affiliation(s)
- Carlos A. Torres-Vitolas
- SCI Foundation, London, United Kingdom
- School of Public Health, Imperial College, London, United Kingdom
- * E-mail:
| | | | | |
Collapse
|
16
|
Aruldas K, Means AR, Titus A, Jacob Y, Rajendiran R, Johnson J, Emmanuel-Fabula M, Puthupalayam Kaliappan S, Kamlakar Juvekar S, Kang G, L. Walson J, Ajjampur SSR. Gender differences in the perceived need for community-wide deworming: Formative qualitative research from the DeWorm3 study, India. PLoS Negl Trop Dis 2020; 14:e0008829. [PMID: 33237928 PMCID: PMC7688162 DOI: 10.1371/journal.pntd.0008829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
Current soil-transmitted helminth (STH) programs target morbidity control with school-based deworming. Increasing interest in steering neglected tropical disease (NTD) programmes from morbidity control towards disease elimination has prompted evaluation of strategies that may interrupt transmission. The feasibility of interrupting transmission of STH with community-wide deworming is being tested in the ongoing DeWorm3 cluster randomized trial. Gender-based perspectives about susceptibility to infection and need for treatment have been shown to influence both health-seeking behaviour and health outcomes. We carried out a qualitative study among men and women in the community to understand their knowledge, beliefs, and attitudes about STH infections and community-wide mass drug administration (cMDA). Eight semi-structured focus group discussions were conducted among men and women residing in the DeWorm3 study site in India-Vellore and Tiruvannamalai districts of Tamil Nadu. Thematic coding was used to analyse the transcripts in ATLAS.ti 8.0. Both men and women in this study demonstrated a high level of STH knowledge but some men had misconceptions that intestinal worms were beneficial. Men and women shared several similar beliefs and attitudes regarding STH treatment. Both believed that adults were likely to have STH infections and both reported that stigma prevented them from seeking treatment. Influenced by gender norms, women were more likely to associate STH infections with inadequate sanitation and hygiene, while men were more likely to believe that those engaged in agricultural work were at risk. Both genders reported a positive attitude towards cMDA for STH. Barriers to cMDA implementation differed by gender; women expressed concern regarding side-effects and drug quality while men were concerned that treatment coverage may be affected due to the absence of people during the day when the drug is distributed. Both men and women perceived the treatment of adults for STH infections to be important, however, the perceived barriers to participating in cMDA differed by gender in this community. The study identified key messages to be incorporated in communication and outreach strategies for cMDA programmes.
Collapse
Affiliation(s)
- Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Angelin Titus
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Yesudoss Jacob
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Rajeshkumar Rajendiran
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jabaselvi Johnson
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Mira Emmanuel-Fabula
- Department of Global Health, University of Washington, Seattle, United States of America
| | | | | | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Judd L. Walson
- Department of Global Health, Medicine, Pediatrics & Epidemiology, University of Washington, Seattle, United States of America
- DeWorm3, Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Sitara Swarna Rao Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
- * E-mail:
| |
Collapse
|
17
|
Geyer RE, Ibikounlé M, Emmanuel-Fabula M, Roll A, Avokpaho E, Elijan A, Wèkè LC, Togbevi CI, Chabi F, Houngbégnon P, Luty AJF, Yard E, Walson JL, Graham S, Means AR. Gender norms and mass deworming program access in Comé, Benin: A qualitative assessment of gender-associated opportunities and challenges to achieving high mass drug administration coverage. PLoS Negl Trop Dis 2020; 14:e0008153. [PMID: 32302298 PMCID: PMC7164589 DOI: 10.1371/journal.pntd.0008153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/19/2020] [Indexed: 12/03/2022] Open
Abstract
The World Health Organization’s Neglected Tropical Disease Roadmap has accelerated progress towards eliminating select neglected tropical diseases (NTDs). This momentum has catalyzed research to determine the feasibility of interrupting transmission of soil-transmitted helminths (STH) using community-wide mass drug administration (MDA). This study aims to identify potential gender-specific facilitators and barriers to accessing and participating in community-wide STH MDA, with the goal of ensuring programs are equitable and maximize the probability of interrupting STH transmission. This research was conducted prior to the launch of community-wide MDA for STH in Comé, Benin. A total of 10 focus group discussions (FGDs) were conducted separately among 40 men, 38 women, and 15 community drug distributors (CDDs). Salient themes included: both men and women believe that community-wide MDA would reduce the financial burden associated with self-treatment, particularly for low income adults. Community members believe MDA should be packaged alongside water, sanitation, and other health services. Women feel past community-wide programs have been disorganized and are concerned these distributions will be similar. Women also expressed interest in increased engagement in the implementation of future community-based public health programs. Men often did not perceive themselves to be at great risk for STH infection and did not express a high demand for treatment. Finally, the barriers discussed by CDDs generally did not align with gender-specific concerns, but rather represented concerns shared by both genders. A door-to-door distribution strategy for STH MDA is preferred by women in this study, as this platform empowers women to participate as health decision makers for their family. In addition, involving women in planning and implementation of community-wide programs may help to increase treatment coverage and compliance. Soil-transmitted helminths (STH) affect an estimated 1.5 billion people globally. The DeWorm3 Project is investigating if it is possible to interrupt transmission of STH with community-wide deworming of individuals of all ages. We conducted focus group discussions with adult men, women, and community drug distributors (CDDs) in Comé, Benin to identify gender-specific facilitators and barriers to accessing and participating in community-wide mass drug administration (MDA) programs. Our findings suggest that door-to-door community-wide MDA may not only improve MDA treatment coverage by increasing access but may also empower women by facilitating increased decision making on behalf of their regarding who is treated and where. Additionally, women may be an untapped resource for strategically reaching missed populations and women reported seeking increased involvement within the deworming of their families. Men did not perceive themselves to be at risk and thus did not have high demand for deworming. Both genders reported that they struggle to afford deworming drugs outside of MDA and that MDA coverage would be higher if treatment was integrated with water and sanitation services. Finally, CDDs generally identified only barriers and facilitators to MDA that were shared by both genders and may require more training to ensure MDA programs are equitable and effectively engage all at risk populations.
Collapse
Affiliation(s)
- Rachel E. Geyer
- Department of Global Health, University of Washington, Seattle, United States of America
- * E-mail:
| | - Moudachirou Ibikounlé
- Département de Zoologie, Faculté des Sciences et Techniques, Université d’Abomey-Calavi 01BP526, Cotonou, Benin
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | - Mira Emmanuel-Fabula
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Amy Roll
- Department of Global Health, University of Washington, Seattle, United States of America
| | | | - Abiguel Elijan
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | | | | | - Félicien Chabi
- Institute de Recherche Clinique du Bénin, Cotonou, Benin
| | | | | | - Elodie Yard
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, United States of America
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Susan Graham
- Department of Global Health, University of Washington, Seattle, United States of America
- Department of Medicine, University of Washington, Seattle, United States of America
- Department of Epidemiology, University of Washington, Seattle, United States of America
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, United States of America
- Division of Life Sciences, Natural History Museum, London, United Kingdom
| |
Collapse
|
18
|
Shoemaker EA, Dale K, Cohn DA, Kelly MP, Zoerhoff KL, Batcho WE, Bougouma C, Nko’Ayissi GB, Meite A, Marfo B, Goepogui A, Telfort MA, Sianipar LR, Traore M, Rimal P, Alfari DA, Anyaike C, Badiane FN, Kargbo-Labour I, Mwingira UJ, Awoussi MS, Stelmach RD, Smith CL, Arney J, Faramand TH, Stukel DM, Pou B, Rotondo LA, Kraemer JD, Baker MC. Gender and neglected tropical disease front-line workers: Data from 16 countries. PLoS One 2019; 14:e0224925. [PMID: 31856174 PMCID: PMC6922366 DOI: 10.1371/journal.pone.0224925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background Delivery of preventive chemotherapy (PC) through mass drug administration (MDA) is used to control or eliminate five of the most common neglected tropical diseases (NTDs). The success of an MDA campaign relies on the ability of drug distributors and their supervisors—the NTD front-line workers—to reach populations at risk of NTDs. In the past, our understanding of the demographics of these workers has been limited, but with increased access to sex-disaggregated data, we begin to explore the implications of gender and sex for the success of NTD front-line workers. Methodology/Principal findings We reviewed data collected by USAID-supported NTD projects from national NTD programs from fiscal years (FY) 2012–2017 to assess availability of sex-disaggregated data on the workforce. What we found was sex-disaggregated data on 2,984,908 trainees trained with financial support from the project. We then analyzed the percentage of males and females trained by job category, country, and fiscal year. During FY12, 59% of these data were disaggregated by sex, which increased to nearly 100% by FY15 and was sustained through FY17. In FY17, 43% of trainees were female, with just four countries reporting more females than males trained as drug distributors and three countries reporting more females than males trained as trainers/supervisors. Except for two countries, there were no clear trends over time in changes to the percent of females trained. Conclusions/Significance There has been a rapid increase in availability of sex-disaggregated data, but little increase in recruitment of female workers in countries included in this study. Women continue to be under-represented in the NTD workforce, and while there are often valid reasons for this distribution, we need to test this norm and better understand gender dynamics within NTD programs to increase equity.
Collapse
Affiliation(s)
| | - Kelly Dale
- WI-HER, Vienna, Virginia, United States of America
| | | | | | | | - Wilfrid E. Batcho
- National Communicable Disease Control Program, Ministry of Health, Cotonou, Republic of Benin
| | - Clarisse Bougouma
- National Neglected Tropical Disease Control Program, Disease Control Directorate, Ministry of Health, Ouagadougou, Burkina Faso
| | - Georges B. Nko’Ayissi
- Malaria and Neglected Tropical Diseases Sub-Department, Ministry of Public Health, Yaoundé, Republic of Cameroon
| | - Aboulaye Meite
- National Control Program for Preventive Chemotherapy Neglected Tropical Diseases, Ministry of Health and Public Hygiene, Abidjan, Republic of Côte d'Ivoire
| | - Benjamin Marfo
- National Neglected Tropical Diseases Program, Ghana Health Service, Accra, Republic of Ghana
| | - André Goepogui
- National Onchocerciasis and Blindness and Neglected Tropical Disease Control Program, National Prevention and Community Health Directorate, Ministry of Health, Conakry, Republic of Guinea
| | - Marc-Aurele Telfort
- National Malaria Control Program, Ministry of Public Health and Population, Port-au-Prince, Republic of Haiti
| | - Lita Renata Sianipar
- Sub-Directorate of Filariasis & Helminthiasis Control, Directorate of Vector Borne Disease Control, Directorate General of Communicable Disease and Environmental Health, Ministry of Health, Jakarta, Republic of Indonesia
| | - Mahamadou Traore
- National Schistosomiasis and Soil-Transmitted Helminths Control Program, Ministry of Health and Public Hygiene, Bamako, Mali
| | - Pradip Rimal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health, Kathmandu, Federal Democratic Republic of Nepal
| | - Djibo Aichatou Alfari
- NTD Control Program, Directorate of the Protection of Public Health, Ministry of Public Health, Niamey, Republic of Niger
| | - Chukwuma Anyaike
- Department of Public Health, Neglected Tropical Diseases Division, Federal Ministry of Health, Abuja, Federal Republic of Nigeria
| | - Fatou N. Badiane
- NTD Control Program, Disease Control Directorate, Ministry of Health and Social Work, Dakar, Senegal
| | - Ibrahim Kargbo-Labour
- Neglected Tropical Diseases Programme, Disease Prevention and Control Directorate, Ministry of Health and Sanitation, Freetown, Republic of Sierra Leone
| | - Upendo J. Mwingira
- Neglected Tropical Diseases Control Programme, Ministry of Health, Dar es Salaam, United Republic of Tanzania
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Marcel S. Awoussi
- National Neglected Tropical Disease Control Program, General Directorate of Health, Ministry of Health and Social Welfare, Lomé, Republic of Togo
| | | | - Carly L. Smith
- Office of Infectious Diseases, US Agency for International Development, Washington, DC, United States of America
| | | | | | | | - Bolivar Pou
- FHI 360, Washington, DC, United States of America
| | | | - John D. Kraemer
- RTI International, Washington, DC, United States of America
- Department of Health Systems Administration, Georgetown University, Washington, DC, United States of America
| | | |
Collapse
|
19
|
Wharton-Smith A, Rassi C, Batisso E, Ortu G, King R, Endriyas M, Counihan H, Hamade P, Getachew D. Gender-related factors affecting health seeking for neglected tropical diseases: findings from a qualitative study in Ethiopia. PLoS Negl Trop Dis 2019; 13:e0007840. [PMID: 31830026 PMCID: PMC6907747 DOI: 10.1371/journal.pntd.0007840] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite known gender-specific differences in terms of prevalence, transmission and exposure to neglected tropical diseases (NTDs), there is limited discussion of the influence of gender in NTD programmes and interventions. There is a paucity of research on how gender interacts with NTD service provision and uptake. This study, part of broader implementation research in Ethiopia, applied a gender lens to health seeking for five NTDs: lymphatic filariasis, podoconiosis, schistosomiasis, soil-transmitted helminth infection and trachoma. METHODOLOGY/PRINCIPAL FINDINGS The study was conducted in a district of the Southern Nations, Nationalities, and Peoples' Region of Ethiopia where the five NTDs are prevalent. A qualitative methodology was adopted to explore participants' perspectives and experiences. Data generation methods included 20 interviews and four focus group discussions. Community members, volunteer Health Development Army leaders, Health Extension Workers and a range of health workers at the health post, health centre and hospital level (n = 59) were purposively sampled. Interviews and focus group discussions were audio recorded, transcribed verbatim into English then analysed through open coding, drawing on constant comparative methods. Gender related factors affected care seeking for NTDs and were described as reasons for not seeking care, delayed care seeking and treating NTDs with natural remedies. Women faced additional challenges in seeking health care due to gender inequalities and power dynamics in their domestic partnerships. Participants recommended raising community awareness about NTDs, however this remains problematic due to gender and social norms around appropriate discourse with members of the opposite gender. CONCLUSIONS/SIGNIFICANCE The findings from this study provide crucial insights into how gender interacts with accessing health services, at different levels of the health system. If we are committed to leaving no one behind and achieving universal health coverage, it is essential to address gender disparities to access and utilisation of interventions delivered by national NTD programmes.
Collapse
Affiliation(s)
| | | | | | | | - Rebecca King
- The Nuffield Centre for International Health & Development, University of Leeds, Leeds, United Kingdom
| | | | | | | | | |
Collapse
|
20
|
Oluwole A, Dean L, Lar L, Salami K, Okoko O, Isiyaku S, Dixon R, Elhassan E, Schmidt E, Thomson R, Theobald S, Ozano K. Optimising the performance of frontline implementers engaged in the NTD programme in Nigeria: lessons for strengthening community health systems for universal health coverage. HUMAN RESOURCES FOR HEALTH 2019; 17:79. [PMID: 31675965 PMCID: PMC6824027 DOI: 10.1186/s12960-019-0419-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/20/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND The control and elimination of Neglected Tropical Diseases (NTDs) is dependent on mass administration of medicines (MAM) in communities and schools by community drug distributers (CDDs) who are supported and supervised by health facility staff (FLHF) and teachers. Understanding how to motivate, retain and optimise their performance is essential to ensure communities accept medicines. This study aimed to capture and translate knowledge, problems and solutions, identified by implementers, to enhance NTD programme delivery at the community level in Nigeria. METHODS Qualitative data was collected through participatory stakeholder workshops organised around two themes: (i) identification of problems and (ii) finding solutions. Eighteen problem-focused workshops and 20 solution-focussed workshops were held with FLHF, CDDs and teachers in 12 purposively selected local government areas (LGA) across two states in Nigeria, Ogun and Kaduna States. RESULT The problems and solutions identified by frontline implementers were organised into three broad themes: technical support, social support and incentives. Areas identified for technical support included training, supervision, human resource management and workload, equipment and resources and timing of MAM implementation. Social support needs were for more equitable drug distributor selection processes, effective community sensitisation mechanisms and being associated with the health system. Incentives identified were both non-financial and financial including receiving positive community feedback and recognition and monetary remuneration. The results led to the development of the 'NTD frontline implementer's framework' which was adapted from the Community Health Worker (CHW) Generic Logic Model by Naimoli et al. (Hum Resour Health 12:56, 2014). CONCLUSION Maximising performance of frontline implementers is key to successful attainment of NTD goals and other health interventions. As NTDs are viewed as a 'litmus test' for universal health coverage, the lessons shared here could cut across programmes aiming to achieve equitable coverage. It is critical to strengthen the collaboration between health systems and communities so that together they can jointly provide the necessary support for frontline implementers to deliver health for all. This research presents additional evidence that involving frontline implementers in the planning and implementation of health interventions through regular feedback before, during and after implementation has the potential to strengthen health outcomes.
Collapse
Affiliation(s)
- Akinola Oluwole
- Sightsavers, Nigeria Country Office, 1 Golf Course road, PO Box 503, Kaduna, Kaduna State Nigeria
| | - Laura Dean
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Luret Lar
- Sightsavers, Nigeria Country Office, University of Jos, Jos, Nigeria
| | | | | | - Sunday Isiyaku
- Sightsavers, Nigeria Country Office, 1 Golf Course road, PO Box 503, Kaduna, Kaduna State Nigeria
| | | | - Elizabeth Elhassan
- Sightsavers, Nigeria Country Office, 1 Golf Course road, PO Box 503, Kaduna, Kaduna State Nigeria
| | | | - Rachael Thomson
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kim Ozano
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
21
|
Cohn DA, Kelly MP, Bhandari K, Zoerhoff KL, Batcho WE, Drabo F, Negussu N, Marfo B, Goepogui A, Lemoine JF, Ganefa S, Massangaie M, Rimal P, Gnandou I, Anagbogu IN, Ndiaye M, Bah YM, Mwingira UJ, Awoussi MS, Tukahebwa EM, Stelmach RD, Mingkwan PC, Pou B, Koroma JB, Rotondo LA, Kraemer JD, Baker MC. Gender equity in mass drug administration for neglected tropical diseases: data from 16 countries. Int Health 2019; 11:370-378. [PMID: 30845318 PMCID: PMC6748770 DOI: 10.1093/inthealth/ihz012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/25/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Gender equity in global health is a target of the Sustainable Development Goals and a requirement of just societies. Substantial progress has been made towards control and elimination of neglected tropical diseases (NTDs) via mass drug administration (MDA). However, little is known about whether MDA coverage is equitable. This study assesses the availability of gender-disaggregated data and whether systematic gender differences in MDA coverage exist. METHODS Coverage data were analyzed for 4784 district-years in 16 countries from 2012 through 2016. The percentage of districts reporting gender-disaggregated data was calculated and male-female coverage compared. RESULTS Reporting of gender-disaggregated coverage data improved from 32% of districts in 2012 to 90% in 2016. In 2016, median female coverage was 85.5% compared with 79.3% for males. Female coverage was higher than male coverage for all diseases. However, within-country differences exist, with 64 (3.3%) districts reporting male coverage >10 percentage points higher than female coverage. CONCLUSIONS Reporting of gender-disaggregated data is feasible. And NTD programs consistently achieve at least equal levels of coverage for women. Understanding gendered barriers to MDA for men and women remains a priority.
Collapse
Affiliation(s)
- Daniel A Cohn
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - Maureen P Kelly
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - Kalpana Bhandari
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | | | - Wilfrid E Batcho
- National Communicable Disease Control Program, Ministry of Health, 01 BP 882, Cotonou, Republic of Benin
| | - François Drabo
- National Neglected Tropical Disease Control Program, Disease Control Directorate, Ministry of Health, Ouagadougou, Burkina Faso
| | - Nebiyu Negussu
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Federal Democratic Republic of Ethiopia
| | - Benjamin Marfo
- National NTD Program, Ghana Health Service, Accra, Republic of Ghana
| | - André Goepogui
- National Onchocerciasis and Blindness and Neglected Tropical Disease Control Program, National Prevention and Community Health Directorate, Ministry of Health, BP 585, Conakry, Republic of Guinea
| | - Jean-Frantz Lemoine
- National Malaria Control Program, Ministry of Public Health and Population, 30 Rue Mercier Laham, Delmas 60, Republic of Haiti
| | - Sitti Ganefa
- Sub-Directorate of Filariasis & Helminthiasis Control, Directorate of Vector Borne Disease Control, Directorate General of Communicable Disease and Environmental Health, Ministry of Health, Jl. Percetakan Negara No. 29, Jakarta, Republic of Indonesia
| | - Marilia Massangaie
- Department of Other Infectious Diseases, Ministry of Health, AV. Eduardo Mondlane e Salvador Allende, Maputo, Republic of Mozambique
| | - Pradip Rimal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health, Teku, Kathmandu, Federal Democratic Republic of Nepal
| | - Issa Gnandou
- National Bilharzia and Soil-Transmitted Helminths Control Program, Ministry of Public Health, Niamey, Republic of Niger
| | - Ifeoma N Anagbogu
- Department of Public Health, Neglected Tropical Diseases Division, Federal Ministry of Health, Federal Secretariat Complex Phase 3, Ahmadu Bello Way, CBD, Abuja, Federal Republic of Nigeria
| | - Mamadou Ndiaye
- Neglected Tropical Disease Control Program, Disease Control Directorate, Ministry of Health and Social Work, Dakar, Republic of Senegal
| | - Yakuba Madina Bah
- NTD Programme, Ministry of Health and Sanitation, Freetown, Republic of Sierra Leone
| | - Upendo J Mwingira
- Neglected Tropical Diseases Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
- National Institute for Medical Research, 2448 Barack Obama Dr, Box 9653, Dar es Salaam, United Republic of Tanzania
| | - Marcel S Awoussi
- National Neglected Tropical Disease Control Program, General Directorate of Health, Ministry of Health and Social Welfare, Lomé, Republic of Togo
| | | | | | - Pia C Mingkwan
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - Bolivar Pou
- FHI 360, 1825 Connecticut Avenue NW, Washington, DC, USA
| | - Joseph B Koroma
- FHI 360, 1st Floor, Marvel House, 148A Giffard Road, East Cantonments, Accra, Ghana
| | - Lisa A Rotondo
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - John D Kraemer
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
- Department of Health Systems Administration, Georgetown University, 3700 Reservoir Road NW, Washington, DC, USA
| | - Margaret C Baker
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| |
Collapse
|
22
|
Krentel A, Wellings K. The role of gender relations in uptake of mass drug administration for lymphatic filariasis in Alor District, Indonesia. Parasit Vectors 2018. [PMID: 29530082 PMCID: PMC5848596 DOI: 10.1186/s13071-018-2689-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The Global Programme to Eliminate Lymphatic Filariasis has set 2020 as a target to eliminate lymphatic filariasis (LF) as a public health problem through mass drug administration (MDA) to all eligible people living in endemic areas. To obtain a better understanding of compliance with LF treatment, a qualitative study using 43 in-depth interviews was carried out in Alor District, Indonesia to explore factors that motivate uptake of LF treatment, including the social and behavioural differences between compliant and non-compliant individuals. In this paper, we report on the findings specific to the role of family and gender relations and how they affect compliance. Results The sample comprised 21 men and 22 women; 24 complied with treatment while 19 did not. Gender relations emerged as a key theme in access, uptake and compliance with MDA. The view that the husband, as head of household, had the power, control, and in some cases the responsibility to influence whether his wife took the medication was common among both men and women. Gender also affected priorities for health care provision in the household as well as overall decision making regarding health in the household. Four models of responsibility for health decision making emerged: (i) responsibility resting primarily with the husband; (ii) responsibility resting primarily with the wife; (iii) responsibility shared equally by both husband and wife; and (iv) responsibility autonomously assumed by each individual for his or her own self, regardless of the course of action of the other spouse. Conclusions (i) Gender relations and social hierarchy influence compliance with LF treatment because they inherently affect decisions taken within the household regarding health; (ii) health care interventions need to take account of the complexity of gender roles; (iii) the fact that women’s power tends to be implicit and not overtly recognised in the household or the community has important implications for health care interventions; (iv) campaigns and other preventive interventions need to take account of the diversity of patterns of health care decision-making and responsibility in specific communities so that social mobilisation messages can be tailored appropriately.
Collapse
Affiliation(s)
- Alison Krentel
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Keppel Street, London, WC1E 7HT, UK. .,Bruyère Research Institute, 85 Primrose Avenue, Room 308-B, Ottawa, ON, K1R 6M1, Canada.
| | - Kaye Wellings
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
23
|
Krentel A, Gyapong M, Mallya S, Boadu NY, Amuyunzu-Nyamongo M, Stephens M, McFarland DA. Review of the factors influencing the motivation of community drug distributors towards the control and elimination of neglected tropical diseases (NTDs). PLoS Negl Trop Dis 2017; 11:e0006065. [PMID: 29211746 PMCID: PMC5718409 DOI: 10.1371/journal.pntd.0006065] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/23/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Community drug distributors or neglected tropical disease (NTD) volunteers have played a crucial role in ensuring the success of mass drug administration (MDA) programs using preventive chemotherapy (PC) for lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma and soil transmitted helminths. In recent years however, a noticeable decline in motivation of some of these volunteers has been perceived, potentially negatively impacting the success of these programs. Potential hypotheses for this change in motivation include the long duration of many MDA programs, the change in sociocultural environments as well as the changes to the programs over time. This literature review identifies factors that affect NTD volunteer performance and motivation, which may be used to influence and improve future programming. METHODOLOGY/PRINCIPAL FINDINGS A systematic search was conducted to identify studies published between January 1995 and September 2016 that investigate factors pertaining to volunteer motivation and performance in NTD drug distribution programs. Searches from several databases and grey literature yielded 400 records, of which 28 articles from 10 countries met the inclusion criteria. Quality assessment of studies was performed using the Critical Appraisal Skills Programme(CASP) checklist. Data pertaining to motivation, performance, retention and satisfaction was extracted and examined for themes. Recurring themes in the literature included monetary and material incentives, intrinsic motivation, gender, cost to participate, and health systems and community support. Of these, community support and the health system were found to be particularly impactful. Very few studies were found to explicitly look at novel incentives for volunteers and very few studies have considered the out of pocket and opportunity costs that NTD volunteers bear carrying out their tasks. CONCLUSIONS/SIGNIFICANCE There is currently great interest in incorporating more attractive incentive schemes for NTD volunteers. However, our results show that the important challenges that volunteers face (cultural, health systems, financial and community related) may have less to do with financial incentives and may actually have a larger impact on their motivation than has previously been understood. Further integration of NTD programs into existing health systems is expected to improve the NTD volunteer working environment. Relevant community engagement related to the MDA program should also provide the supportive environment needed in the community to support NTD volunteers. Programs need to consider these issues to improve working conditions for NTD volunteers.
Collapse
Affiliation(s)
| | - Margaret Gyapong
- Institute for Health Research, University of Health and Allied Sciences, Ho Ghana
| | | | - Nana Yaa Boadu
- Health and Nutrition Bureau, Global Affairs Canada, Ottawa Canada
| | | | - Mariana Stephens
- NTD Support Center, Task Force for Global Health, Decatur GA United States of America
| | - Deborah A. McFarland
- Rollins School of Public Health, Emory University Atlanta GA United States of America
| |
Collapse
|
24
|
Theobald S, MacPherson EE, Dean L, Jacobson J, Ducker C, Gyapong M, Hawkins K, Elphick-Pooley T, Mackenzie C, Kelly-Hope LA, Fleming FM, Mbabazi PS. 20 years of gender mainstreaming in health: lessons and reflections for the neglected tropical diseases community. BMJ Glob Health 2017; 2:e000512. [PMID: 29177100 PMCID: PMC5687534 DOI: 10.1136/bmjgh-2017-000512] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/05/2022] Open
Abstract
Neglected tropical diseases (NTDs) affect the poorest of the poor. NTD programmes can and should rise to the challenge of playing a part in promoting more gender equitable societies. Gender equity shapes poverty and the experience of disease in multiple ways; yet to date, there has been little attention paid to gender equity in NTD control efforts. Drawing on a synthesis of relevant literature, the tacit knowledge and experience of the authors, and discussions at a meeting on women, girls and NTDs, this analysis paper distills five key lessons from over 20 years of gender mainstreaming in health. The paper links this learning to NTDs and Mass Drug Administration (MDA). Our first lesson is that tailored gender frameworks support gender analysis within research and programming. We present a gender review framework focusing on different MDA strategies. Second, gender interplays with other axes of inequality, such as disability and geographical location; hence, intersectionality is important for inclusive and responsive NTD programmes. Third, gender, power and positionality shape who is chosen as community drug distributors (CDDs). How CDDs interact with communities and how this interface role is valued and practised needs to be better understood. Fourth, we need to unpack the gender and power dynamics at household level to assess how this impacts MDA coverage and interactions with CDDs. Finally, we need to collect and use sex disaggregated data to support the development of more equitable and sustainable NTD programmes.
Collapse
Affiliation(s)
- Sally Theobald
- Department of International Public Health, COUNTDOWN Consortium and RiNGs Consortium, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Eleanor E MacPherson
- Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Laura Dean
- Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Julie Jacobson
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | | | - Margaret Gyapong
- COUNTDOWN Consortium, Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Kate Hawkins
- RiNGs Consortium and Pamoja Communications, Brighton, UK
| | | | - Charles Mackenzie
- Department of Parasitology, Liverpool School of Tropical Medicine, Decatur, Georgia, USA
| | - Louise A Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Fiona M Fleming
- Schistosomiasis Control Initiative, Imperial College London, London, UK
| | - Pamela S Mbabazi
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
25
|
Bangert M, Molyneux DH, Lindsay SW, Fitzpatrick C, Engels D. The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals. Infect Dis Poverty 2017; 6:73. [PMID: 28372566 PMCID: PMC5379574 DOI: 10.1186/s40249-017-0288-0] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/16/2017] [Indexed: 01/14/2023] Open
Abstract
The Sustainable Development Goals (SDGs) call for an integrated response, the kind that has defined Neglected Tropical Diseases (NTDs) efforts in the past decade.NTD interventions have the greatest relevance for SDG3, the health goal, where the focus on equity, and its commitment to reaching people in need of health services, wherever they may live and whatever their circumstances, is fundamentally aligned with the target of Universal Health Coverage. NTD interventions, however, also affect and are affected by many of the other development areas covered under the 2030 Agenda. Strategies such as mass drug administration or the programmatic integration of NTD and WASH activities (SDG6) are driven by effective global partnerships (SDG17). Intervention against the NTDs can also have an impact on poverty (SDG1) and hunger (SDG2), can improve education (SDG4), work and economic growth (SDG8), thereby reducing inequalities (SDG10). The community-led distribution of donated medicines to more than 1 billion people reinforces women's empowerment (SDG5), logistics infrastructure (SDG9) and non-discrimination against disability (SDG16). Interventions to curb mosquito-borne NTDs contribute to the goals of urban sustainability (SDG11) and resilience to climate change (SDG13), while the safe use of insecticides supports the goal of sustainable ecosystems (SDG15). Although indirectly, interventions to control water- and animal-related NTDs can facilitate the goals of small-scale fishing (SDG14) and sustainable hydroelectricity and biofuels (SDG7).NTDs proliferate in less developed areas in countries across the income spectrum, areas where large numbers of people have little or no access to adequate health care, clean water, sanitation, housing, education, transport and information. This scoping review assesses how in this context, ending the epidemic of the NTDs can impact and improve our prospects of attaining the SDGs.
Collapse
Affiliation(s)
- Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - David H. Molyneux
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Dirk Engels
- Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| |
Collapse
|
26
|
Paige SB, Friant S, Clech L, Malavé C, Kemigabo C, Obeti R, Goldberg TL. Combining Footwear with Public Health Iconography to Prevent Soil-Transmitted Helminth Infections. Am J Trop Med Hyg 2016; 96:205-213. [PMID: 27821692 DOI: 10.4269/ajtmh.15-0910] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 10/06/2016] [Indexed: 12/26/2022] Open
Abstract
Shoes are effective for blocking soil-transmitted helminths (STHs) that penetrate the skin. Unfortunately, shoe-wearing is uncommon in many areas where STHs are prevalent, in part because local populations are unaware of the health benefits of wearing shoes. This is especially true in low-literacy populations, where information dissemination through written messages is not possible. We launched a public health intervention that combines a public health image with sandals. The image is a "lenticular image" that combines two alternating pictures to depict the efficacy of shoes for preventing STH infection. This image is adhered to the shoe, such that the message is linked directly to the primary means of prevention. To create a culturally appropriate image, we conducted five focus group discussions, each with a different gender and age combination. Results of focus group discussions reinforced the importance of refining public health messages well in advance of distribution so that cultural acceptability is strong. After the image was finalized, we deployed shoes with the image in communities in western Uganda where hookworm is prevalent. We found that the frequency of shoe-wearing was 25% higher in communities receiving the shoes than in control communities. Microscopic analyses of fecal samples for parasites showed a sustained reduction in infection intensity for parasites transmitted directly through the feet when people received shoes with a public health image. Our results show that combining culturally appropriate images with public health interventions can be effective in low-literacy populations.
Collapse
Affiliation(s)
- Sarah B Paige
- Global Health Institute, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sagan Friant
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin.,Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lucie Clech
- Department of Anthropology, Stanford University, Stanford, California
| | - Carly Malavé
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Richard Obeti
- Kabarole District Health Office, Fort Portal, Uganda
| | - Tony L Goldberg
- Global Health Institute, University of Wisconsin-Madison, Madison, Wisconsin. .,Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
27
|
RASTI S, DEHGHANI R, KHALEDI HNAEIMI, TAKHTFIROOZEH SM, CHIMEHI E. Uncommon Human Urinary Tract Myiasis Due to Psychoda Sp. Larvae, Kashan, Iran: A Case Report. IRANIAN JOURNAL OF PARASITOLOGY 2016; 11:417-421. [PMID: 28127350 PMCID: PMC5256061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/12/2016] [Indexed: 11/02/2022]
Abstract
Contamination of human and animal body tissues with flies' larvae and diptera cause myiasis. A 26 yr old female patient refers to Kashan Shahid Beheshti Hospital, central Iran because of urogenital infection, pain in the right part of stomach, smelly and reddish vaginal discharge and frequent urination. In the first checking, urine sample was taken. In the sample, active and alive larvae were seen. The live samples were taken to the Environmental Health Department Lab of Kashan University of Medical Sciences in clean glass jars. In the morphological survey, Psychoda sp larvae were identified. In Iran, this study is the first report of this species of larva that causes urinary myiasis. This fly larva is not carnivore or bloodsucker and feeds on bacterial agents. Observance of personal hygiene especially during defecation and urination is essential to prevent contamination of this type of myiasis.
Collapse
Affiliation(s)
- Sima RASTI
- Dept. of Parasitology and Mycology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Rouhullah DEHGHANI
- Social Determinants of Health (SDH) Research Center, Department of Environmental Health, Kashan University of Medical Sciences, Kashan, Iran
| | | | | | - Elahe CHIMEHI
- Dept. of Environmental Health, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| |
Collapse
|
28
|
Bardosh K. Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases. Infect Dis Poverty 2014; 3:35. [PMID: 25320672 PMCID: PMC4197218 DOI: 10.1186/2049-9957-3-35] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 09/16/2014] [Indexed: 11/23/2022] Open
Abstract
Neglected Tropical Diseases (NTDs) are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the “neglected” status of applied social science research on NTDs. In light of the 2020 targets, this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions. Five priority areas are discussed, including on policy processes, health systems capacity, compliance and resistance to interventions, education and behaviour change, and community participation. The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes, contemporary efforts underutilise this potential. This is reflective of the dominance of top-down information flows and technocratic approaches in global health. To counter this tendency, social research needs to be more than an afterthought; integrating social inquiry into the planning, monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions. More emphasis on social science perspectives can also help link NTD control to broader social determinants of health, especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.
Collapse
Affiliation(s)
- Kevin Bardosh
- Centre of African Studies, School of Social and Political Science, College of Humanities and Social Science, The University of Edinburgh, 58 George Square, Edinburgh, EH8 9LD UK ; Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| |
Collapse
|
29
|
Vialle-Valentin CE, Serumaga B, Wagner AK, Ross-Degnan D. Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries. Health Policy Plan 2014; 30:1044-52. [PMID: 25255920 DOI: 10.1093/heapol/czu107] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 12/15/2022] Open
Abstract
The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of financial risk protection and consumer education about generic medicines in global efforts towards improving treatment of chronic diseases.
Collapse
Affiliation(s)
- Catherine E Vialle-Valentin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
| | - Brian Serumaga
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
| |
Collapse
|
30
|
Abstract
Emerging evidence over the past decade has implicated helminth infections as important yet stealth causes of adverse pregnancy outcomes and impaired women's reproductive health. The two most important helminth infections affecting women living in poverty in Africa and elsewhere in the developing world are hookworm infection and schistosomiasis. In Africa alone, almost 40 million women of childbearing age are infected with hookworms, including almost 7 million pregnant women who are at greater risk of severe anemia, higher mortality, and experiencing poor neonatal outcome (reduced birth weight and increased infant mortality). Possibly, tens of millions of women in Africa also suffer from female genital schistosomiasis associated with genital itching and pain, stress incontinence, dyspareunia, and infertility and experience social stigma and depression. Female genital schistosomiasis also is linked to horizontal transmission of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and it may represent one of Africa's major cofactors in its AIDS epidemic. There is urgency to expand mass drug administration efforts for hookworm and schistosomiasis to include women of reproductive age and to shape new policies and advocacy initiatives for women's global health to include helminth control. In parallel is a requirement to better link global health programs for HIV and AIDS and malaria with helminth control and to simultaneously launch initiatives for research and development.
Collapse
|