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Sinha A, Mohapatra S, Sahoo KC, Mohanty S, Sahoo B, Pati S, Sahoo PK. Motivation-opportunity-ability-behaviour of community members and program implementers towards mass drug administration for lymphatic filariasis elimination in India: a systematic review and implementation priority. Trans R Soc Trop Med Hyg 2024; 118:426-435. [PMID: 38506271 DOI: 10.1093/trstmh/trae008] [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: 04/13/2023] [Revised: 12/20/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
Lymphatic filariasis (LF) is a significant public health issue in India. Despite 10-15 rounds of mass drug administration (MDA) in India, the global LF elimination target of 2030 appears challenging. To strengthen the program, community and provider perspectives on ways to bridge a gap in MDA are needed. Through the motivation-opportunity-ability-behaviour (MOAB) lens, we systematically reviewed the facilitators and barriers encountered in LF elimination in India. We followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched PubMed, Embase, ProQuest and Google Scholar databases to explore factors related to MDA program implementation in India through 30 June 2021. We analysed the data using a thematic framework. We identified 576 studies; of these, 20 studies were included. This review revealed that the public health system for distributing MDA drugs in India created a better enabling environment, including zero out-of-pocket expenditure, door-step distribution of medicines and ample capacity-building training and follow-up. However, community members were unaware of the rationale for drug consumption, leading to a gap in drug distribution and consumption. Motivation is required among community members, which suggests capacity-building training for service providers to counsel the community.
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Affiliation(s)
- Abhinav Sinha
- Health Technology Assessment in India, Regional Resource Hub, ICMR-Regional Medical Research Centre, Bhubaneswar 751023, Odisha, India
| | - Sumegha Mohapatra
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, Odisha, India
| | - Krushna Chandra Sahoo
- Health Technology Assessment in India, Regional Resource Hub, ICMR-Regional Medical Research Centre, Bhubaneswar 751023, Odisha, India
| | - Shubhashisha Mohanty
- Joint Director of Health Services, National Vector Borne Disease Control Programme, Department of Health and Family Welfare, Government of Odisha, Odisha, India
| | - Banamber Sahoo
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, Odisha, India
| | - Sanghamitra Pati
- Health Technology Assessment in India, Regional Resource Hub, ICMR-Regional Medical Research Centre, Bhubaneswar 751023, Odisha, India
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Amanyi-Enegela JA, Badaki JA, Alege GO, Okunade F, Kumbur J, Ishaya R, Ashikeni D, Qureshi MB, Sankar G. Community Feedback on Mass Medicines Administration for Neglected Tropical Diseases in Federal Capital Territory, Abuja, Nigeria. Trop Med Infect Dis 2024; 9:126. [PMID: 38922038 PMCID: PMC11209482 DOI: 10.3390/tropicalmed9060126] [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: 04/23/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
The World Health Organization (WHO) recommends the use of annual mass drug administration (MDA) as the strategy for controlling and eliminating the five preventive chemotherapy neglected tropical diseases (PC-NTDs). The success of MDAs hinges on community acceptance, active participation, and compliance. This study aimed to explore the experiences and perceptions of community members, to obtain a more thorough understanding of their openness and willingness to participate in MDA and other NTD elimination activities. A mixed-methods approach was employed, utilizing qualitative and quantitative methods for comprehensive data collection. Eighteen key informant interviews (KIIs) and sixteen focus group discussions (FGDs) were conducted to explore community engagement, participation, medication utilization, and programme perception. Triangulation of findings from interviews and discussions with household survey results was performed to gain a deeper understanding of emerging themes. The household survey involved interviewing 1220 individuals (Abaji: 687; Bwari: 533). Audio tapes recorded KIIs and FGDs, with interview transcripts coded using Nvivo 12.0 software based on predefined themes. Descriptive analysis using SPSS version 21 was applied to quantitative data. Results indicated high awareness of mass drug administration (MDA) campaigns in both area councils (Abaji: 84.9%; Bwari: 82.9%), with a small percentage claiming ignorance (15.1%), attributed to lack of information or absence during health campaigns. Respondents primarily participated by taking medication (82.5%), with minimal involvement in other MDA campaigns. Perception of medicines was generally positive, with a significant association between participation level and performance rating (p < 0.05). The study recommends leveraging high awareness and community responsiveness to enhance engagement in various MDA activities, ensuring sustainability and ownership of the programme.
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Affiliation(s)
- Juliana Ajuma Amanyi-Enegela
- Inclusive Eye Health and Neglected Tropical Diseases Initiative, CBM Christoffel-Blindenmission Christian Blind Mission e.V., Wellington House, East Road, Cambridge CB1 1BH, UK
| | | | | | - Faizah Okunade
- CBM Christoffel-Blindenmission Christian Blind Mission e.V Nigeria Country Office, 13 Okemesi Crescent, Garki 2, Federal Capital Territory, Abuja 900103, Nigeria
| | - Joseph Kumbur
- CBM Christoffel-Blindenmission Christian Blind Mission e.V Nigeria Country Office, 13 Okemesi Crescent, Garki 2, Federal Capital Territory, Abuja 900103, Nigeria
| | - Rinpan Ishaya
- HANDS, 5A Naomi Jugu Drive, Rayfield, Jos, Nigeria (D.A.)
| | | | - Mohammad Babar Qureshi
- Inclusive Eye Health and Neglected Tropical Diseases Initiative, CBM Christoffel-Blindenmission Christian Blind Mission e.V., Wellington House, East Road, Cambridge CB1 1BH, UK
| | - Girija Sankar
- Inclusive Eye Health and Neglected Tropical Diseases Initiative, CBM Christoffel-Blindenmission Christian Blind Mission e.V., Wellington House, East Road, Cambridge CB1 1BH, UK
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Kura K, Stolk WA, Basáñez MG, Collyer BS, de Vlas SJ, Diggle PJ, Gass K, Graham M, Hollingsworth TD, King JD, Krentel A, Anderson RM, Coffeng LE. How Does the Proportion of Never Treatment Influence the Success of Mass Drug Administration Programs for the Elimination of Lymphatic Filariasis? Clin Infect Dis 2024; 78:S93-S100. [PMID: 38662701 PMCID: PMC11045024 DOI: 10.1093/cid/ciae021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Mass drug administration (MDA) is the cornerstone for the elimination of lymphatic filariasis (LF). The proportion of the population that is never treated (NT) is a crucial determinant of whether this goal is achieved within reasonable time frames. METHODS Using 2 individual-based stochastic LF transmission models, we assess the maximum permissible level of NT for which the 1% microfilaremia (mf) prevalence threshold can be achieved (with 90% probability) within 10 years under different scenarios of annual MDA coverage, drug combination and transmission setting. RESULTS For Anopheles-transmission settings, we find that treating 80% of the eligible population annually with ivermectin + albendazole (IA) can achieve the 1% mf prevalence threshold within 10 years of annual treatment when baseline mf prevalence is 10%, as long as NT <10%. Higher proportions of NT are acceptable when more efficacious treatment regimens are used. For Culex-transmission settings with a low (5%) baseline mf prevalence and diethylcarbamazine + albendazole (DA) or ivermectin + diethylcarbamazine + albendazole (IDA) treatment, elimination can be reached if treatment coverage among eligibles is 80% or higher. For 10% baseline mf prevalence, the target can be achieved when the annual coverage is 80% and NT ≤15%. Higher infection prevalence or levels of NT would make achieving the target more difficult. CONCLUSIONS The proportion of people never treated in MDA programmes for LF can strongly influence the achievement of elimination and the impact of NT is greater in high transmission areas. This study provides a starting point for further development of criteria for the evaluation of NT.
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Affiliation(s)
- Klodeta Kura
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Benjamin S Collyer
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter J Diggle
- Centre for Health Informatics, Computing and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Katherine Gass
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia, USA
| | - Matthew Graham
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Jonathan D King
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Alison Krentel
- Bruyère Research Institute, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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George NS, David SC, Nabiryo M, Sunday BA, Olanrewaju OF, Yangaza Y, Shomuyiwa DO. Addressing neglected tropical diseases in Africa: a health equity perspective. Glob Health Res Policy 2023; 8:30. [PMID: 37491338 PMCID: PMC10367333 DOI: 10.1186/s41256-023-00314-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
Africa accounts for over one-third of the global burden of neglected tropical diseases (NTDs). Although continental efforts have been made to combat these diseases, there still exists a significant gap in the fight, ranging from a lack of data to multisectoral participation and, most critically, health inequity. Here, we assess the effort made to combat challenges caused by health disparities to prevent and control neglected tropical diseases. This article engages a health equity view to addressing the need for inclusion in achieving universal health coverage towards eradicating NTDs and outlines strategies to achieve such. Health disparities exist, and there is substantial and irrefutable evidence for them. Inequitable distribution and limited access to basic and essential life resources such as water, housing, toilets, soap, and literacy continue to facilitate the existence of NTDs such as Schistosomiasis, soil-transmitted helminths, and trachoma, the occurrence of which can be avoided if affected populations have better access to those resources. To eradicate NTDs, health disparities must be addressed to provide excellent health care to all populations and adequate universal health coverage for long-term sustainability. NTD programmes need to be data-driven to ensure better decision-making and ensure the inclusion of diverse population groups including women, children, and youths. This will ensure that no one is left behind, drawing upon the sustainable development goals. Community participation and engagement should also be considered as an essential approach to ensure people are at the centre of health programmes and their implementation.
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Affiliation(s)
| | | | - Maxencia Nabiryo
- Integrated Community Health Initiative Organization, Kampala, Uganda
- School of Public Health, Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Yonah Yangaza
- Muhimbi University of Heath and Allied Science, Dar es Salaam, Tanzania
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Halwiindi H, Chooka L, Phiri MM, Tapisha B, Masenga SK, Mudenda J, Chimfwembe K, Mugode M, Hamooya BM. Reach and uptake of mass drug administration for worm infections through health facility-, school-, and community-based approaches in two districts of Zambia: a call for scale-up. Epidemiol Infect 2023; 151:e183. [PMID: 37288508 PMCID: PMC10644052 DOI: 10.1017/s0950268823000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
Helminthiases cause significant health deficiencies among children. Mass administration of anthelminthic drugs has had significant results to counter these effects. We assessed the effects on and determinants of treatment coverage of community-directed treatment among children in Zambia, using cross-sectional survey data, and using chi-square test and multilevel mixed-effects model. Of 1,416 children, 51.5% were males and 48.5% were females, while 52.7%, were school-age, and 47.3% were preschool-age. Overall treatment coverage was 53.7% (95% confidence interval (CI) 51.1, 56.4). More preschool-age children were treated compared to school-age ones, 65.2% versus 43.4%, P < 0.001. Similarly, more children under community-directed intervention were treated compared to regular mass drug administration (65.2% versus 51.1 %, P < 0.001). Treatment among school-age participants was associated with being male (Adjusted Odds Ratio (AOR 1.83, 95%CI 1.23-2.72), receiving community-directed treatment (AOR 5.53; 95%CI 3.41-8.97), and shorter distance to health facility (AOR 2.20; 95%CI 1.36-3.56). Among preschool-aged participants, treatment was associated with being residents of Siavonga district (AOR 0.03; 95%CI 0.01-0.04) and shorter distance to health facility (AOR 0.35; 95%CI 0.21-0.59). Community-directed treatment can be used to increase treatment coverage, thereby contribute to 2030 vision of ending epidemics of neglected tropical diseases.
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Affiliation(s)
| | - Lubombo Chooka
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Masauso Moses Phiri
- School of Medicine, Department of Pathology and Microbiology, University of Zambia, Lusaka, Zambia
| | - Buumba Tapisha
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Sepiso K. Masenga
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
| | - Jolezya Mudenda
- School of Medicine, Department of Pathology and Microbiology, University of Zambia, Lusaka, Zambia
| | | | - Mwitwa Mugode
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Benson M. Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
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Dial NJ, Croft SL, Chapman LAC, Terris-Prestholt F, Medley GF. Challenges of using modelling evidence in the visceral leishmaniasis elimination programme in India. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001049. [PMID: 36962829 PMCID: PMC10021829 DOI: 10.1371/journal.pgph.0001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/25/2022] [Indexed: 06/18/2023]
Abstract
As India comes closer to the elimination of visceral leishmaniasis (VL) as a public health problem, surveillance efforts and elimination targets must be continuously revised and strengthened. Mathematical modelling is a compelling research discipline for informing policy and programme design in its capacity to project incidence across space and time, the likelihood of achieving benchmarks, and the impact of different interventions. To gauge the extent to which modelling informs policy in India, this qualitative analysis explores how and whether policy makers understand, value, and reference recently produced VL modelling research. Sixteen semi-structured interviews were carried out with both users- and producers- of VL modelling research, guided by a knowledge utilisation framework grounded in knowledge translation theory. Participants reported that barriers to knowledge utilisation include 1) scepticism that models accurately reflect transmission dynamics, 2) failure of modellers to apply their analyses to specific programme operations, and 3) lack of accountability in the process of translating knowledge to policy. Political trust and support are needed to translate knowledge into programme activities, and employment of a communication intermediary may be a necessary approach to improve this process.
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Affiliation(s)
- Natalie J. Dial
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon L. Croft
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lloyd A. C. Chapman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graham F. Medley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Baker MC, Bardosh K, Fitch E, Mbabazi PS, Mwingira U, Direny A, Dean L, Sutherland EG, Krentel A. Incorporating qualitative research methods into the monitoring and evaluation of neglected tropical disease programmes: a scoping literature review. Int Health 2021; 13:504-513. [PMID: 34614183 PMCID: PMC8643435 DOI: 10.1093/inthealth/ihab059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Abstract
This publication addresses the limited use of qualitative methods in neglected tropical disease (NTD) programmes. It describes a scoping literature review conducted to inform the development of a guide to inform the use of rapid qualitative assessments to strengthen NTD mass drug administration (MDA) programmes. The review assessed how qualitative methods are currently used by NTD programmes and identified qualitative approaches from other health and development programmes with the potential to strengthen the design of MDA interventions. Systematic review articles were reviewed and searched using key terms conducted on Google Scholar and PubMed. Results show that methods used by NTD programmes rely heavily on focus group discussions and in-depth interviews, often with time-consuming analysis and limited information on how results are applied. Results from other fields offered insight into a wider range of methods, including participatory approaches, and on how to increase programmatic uptake of findings. Recommendations on how to apply these findings to NTD control are made. The topic of human resources for qualitative investigations is explored and a guide to improve MDAs using qualitative methods is introduced. This guide has direct applicability across the spectrum of NTDs as well as other public health programmes.
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Affiliation(s)
- Margaret C Baker
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Kevin Bardosh
- Center for One Health Research, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Fitch
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Pamela S Mbabazi
- Department of Neglected Tropical Diseases, World Health Organization, 1221 Geneva 27, Switzerland
| | - Upendo Mwingira
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Abdel Direny
- CORUS International, Washington DC, WA 20036, USA
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Elizabeth G Sutherland
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, K1G5Z3, Canada
- Bruyere Research Institute, Ottawa, K1N 5C8, Canada
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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.
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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
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Graeff-Teixeira C, Favero V, de Souza RP, Pascoal VF, Bittencourt HR, Fukushige M, Geiger SM, Negrão-Corrêa D. Use of Schistosoma mansoni soluble egg antigen (SEA) for antibody detection and diagnosis of schistosomiasis: The need for improved accuracy evaluations of diagnostic tools. Acta Trop 2021; 215:105800. [PMID: 33352167 DOI: 10.1016/j.actatropica.2020.105800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023]
Abstract
Many antigens for use in antibody-detection systems for schistosomiasis have been investigated over the past 40 years. In particular, soluble egg antigens (SEA) are still widely used in enzyme-linked immunosorbent assays (ELISAs) for detection of immunoglobulin classes and subclasses. Here, we conducted a literature review to examine accuracy evaluations of SEA-Immunoglobulin G (IgG)-ELISAs performed to detect Schistosoma mansoni infections and published between 1979 and 2019. S. mansoni is the main causative agent for intestinal schistosomiasis in many countries in Africa and Central and South America. After retrieving 214 relevant abstracts from the PubMed database, we selected 15 publications to undergo a full review. Sensitivity and specificity values varied from 71 to 99%, and from 6 to 100%, respectively. In addition, 11/15 studies did not state confidence intervals. Therefore, the findings from this review indicate that after four decades, we still do not have consistent evaluation estimates of SEA-IgG-ELISAs. Antigen mass per well and dilution of test sera in these articles varied from 0.018 µg to 1.5 µg, and from 1:50 to 1:500, respectively. Most of the reported accuracy evaluations used control sera which were selected based on parasitological examinations for egg detection, although ill-defined criteria were also noted. The number and composition of control serum panels was considered not adequate in approximately half of the studies. It is also noteworthy that among more than 30 diagnostic antigen preparations under development since the 1970s, most were not validated in the field and they failed to reach populations in need. Thus, attention to guidelines for standardization, estimations of accuracy, and reporting of results is needed to facilitate coordinated efforts aimed at schistosomiasis control and elimination.
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Dial NJ, Medley GF, Croft SL, Mahapatra T, Priyamvada K, Sinha B, Palmer L, Terris-Prestholt F. Costs and outcomes of active and passive case detection for visceral leishmaniasis (Kala-Azar) to inform elimination strategies in Bihar, India. PLoS Negl Trop Dis 2021; 15:e0009129. [PMID: 33534836 PMCID: PMC7886142 DOI: 10.1371/journal.pntd.0009129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/16/2021] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective case identification strategies are fundamental to capturing the remaining visceral leishmaniasis (VL) cases in India. To inform government strategies to reach and sustain elimination benchmarks, this study presents costs of active- and passive- case detection (ACD and PCD) strategies used in India's most VL-endemic state, Bihar, with a focus on programme outcomes stratified by district-level incidence. METHODS Expenditure analysis was complemented by onsite micro-costing to compare the cost of PCD in hospitals alongside index case-based ACD and a combination of blanket (house-to-house) and camp ACD from January to December 2018. From the provider's perspective, a cost analysis evaluated the overall programme cost of each activity, the cost per case detected, and the cost of scaling up ACD. RESULTS During 2018, index case-based ACD, blanket and camp ACD, and PCD reported 1,497, 131, and 1,983 VL-positive cases at a unit cost of $522.81, $4,186.81, and $246.79, respectively. In high endemic districts, more VL cases were identified through PCD while in meso- and low-endemic districts more cases were identified through ACD. The cost of scaling up ACD to identify 3,000 additional cases ranged from $1.6-4 million, depending on the extent to which blanket and camp ACD was relied upon. CONCLUSION Cost per VL test conducted (rather than VL-positive case identified) may be a better metric estimating unit costs to scale up ACD in Bihar. As more VL cases were identified in meso-and low-endemic districts through ACD than PCD, health authorities in India should consider bolstering ACD in these areas. Blanket and camp ACD identified fewer cases at a higher unit cost than index case-based ACD. However, the value of detecting additional VL cases early outweighs long-term costs for reaching and sustaining VL elimination benchmarks in India.
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Affiliation(s)
- Natalie J. Dial
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graham F. Medley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon L. Croft
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanmay Mahapatra
- CARE India Solutions for Sustainable Development, Patna, Bihar, India
| | | | - Bikas Sinha
- CARE India Solutions for Sustainable Development, Patna, Bihar, India
| | | | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Njomo DW, Kimani BW, Kibe LW, Okoyo C, Omondi WP, Sultani HM. Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya. PLoS Negl Trop Dis 2020; 14:e0009012. [PMID: 33370300 PMCID: PMC7793263 DOI: 10.1371/journal.pntd.0009012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 01/08/2021] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
Community drug distributors (CDDs) who are volunteers have the responsibility of awareness creation, household census, drug distribution and record-keeping and are thus key stakeholders in the campaign for Lymphatic Filariasis (LF) elimination. Taking into account their experiences and perceptions is important for a successful elimination campaign. We conducted a qualitative study in 2018 to identify implementation challenges and opportunities for improved mass drug administration (MDA) uptake based on the CDDs perceptions and experiences. Within a larger study that used mixed methods quasi-experimental design, we collected qualitative data from two wards in Kaloleni Sub-County of Kilifi County which was purposively selected owing to its low, 56% and 50.5% treatment coverage in 2015 and 2016 respectively. Focus group discussions (FGDs) (n = 8) and in-depth interviews (IDIs) (n = 8) with CDDs, IDIs (n = 22) with opinion leaders and IDIs (n = 8) with health workers were conducted and the data analyzed by QSR NVIVO version 10 according to thematic areas. The results showed that based on the perceptions and experiences of the CDDs, several challenges: communities’ refusal to take the drugs; absenteeism during MDA; non-adherence to CDDs selection criteria; inadequacy in number of CDDs engaged during the campaign and training provided; insufficiency of drugs issued to CDDs; lack of CDDs supervision and low motivation negatively impact on MDA uptake. Opportunities to address the challenges included: awareness creation on MDA, health education on LF and observation of hygiene during drug administration, increased duration of awareness creation and drug administration, adherence to CDDs selection criteria and putting into consideration the vastness of an area and population density while deploying CDDs. Other opportunities include: improved CDDs training and scheduling; issuing of enough drugs to CDDs to meet the communities’ demand and improved supervision and motivation of CDDs. Addressing the challenges highlighted is an important step of maximizing MDA uptake. The opportunities presented need to be considered by the NTD program personnel, the county health personnel and the community while planning the implementation of MDA campaigns. Elephantiasis infection which is common in tropical areas is targeted for elimination globally through delivery of drugs to all populations living in areas where infections occur. Community Drug Distributors (CDDs) are persons who live in the affected communities and who volunteer themselves to distribute drugs after receiving training from the health care workers. Understanding the challenges and opportunities for improved community drug uptake from the perspectives and experiences of the CDDs is important for a successful elimination campaign. As part of a larger study to address barriers of drug uptake in Kenya, we collected qualitative data to explore the challenges and opportunities for improved drug uptake in two wards of Kilifi County. The data was collected through focus group discussions and in-depth interviews and analyzed. For drug uptake to be improved, the CDDs’ mentioned challenges related to how their selection is done, number of CDDs engaged, quality of their training, quantities of drugs issued to them, supervision and motivation that need to be addressed. The communities targeted for treatment need well scheduled health education activities on elephantiasis, awareness creation on drug distribution and drug reaction for them to understand the importance of receiving the treatment. These findings suggest the need for strong collaborations between NTD program, county health personnel and the community that are useful in the planning the implementation of successful national programs.
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Affiliation(s)
- Doris W. Njomo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- * E-mail: ,
| | - Bridget W. Kimani
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lydiah W. Kibe
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Wyckliff P. Omondi
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Hadley M. Sultani
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
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12
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de Souza DK, Gass K, Otchere J, Htet YM, Asiedu O, Marfo B, Biritwum NK, Boakye DA, Ahorlu CS. Review of MDA registers for Lymphatic Filariasis: Findings, and potential uses in addressing the endgame elimination challenges. PLoS Negl Trop Dis 2020; 14:e0008306. [PMID: 32407319 PMCID: PMC7252669 DOI: 10.1371/journal.pntd.0008306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/27/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Lymphatic filariasis (LF) is endemic in Ghana, and the country has implemented the GPELF strategy since 2000 with significant progress made in the control of the disease. However, after several years of mass drug administration (MDA) implementation, there is persistent transmission in 17 of the 98 endemic districts in the country. Current approaches to surveillance are clearly unable to target untreated individuals and new strategies are required to address the endgame challenges to enhance LF elimination as a public health problem in endemic countries. Community registers are used during MDAs to enumerate community members, their age, gender, house numbers, and records of their participation in MDAs. These MDA registers represent an untapped opportunity to identify and characterize non-compliance and inform appropriate programmatic actions. In this study, we analyzed the data presented in the registers to assess the coverage and individuals’ compliance in MDA. Methods The information in the MDA registers were assessed to verify the reported coverages obtained from the district. The community registers were obtained from the district health offices and the data from each individual record was entered into a database. A simple questionnaire was used to cross-check the participation of study participants in the 2017 MDA. The questionnaire solicited data on: participation in the 2017 MDA, reasons for not taking part in the MDA, adverse events experienced, what was done for the adverse events, and willingness to participate in subsequent MDAs. Results We found that 40.1% of the population in the registers missed at least one MDA in 3 years (2016–2018) and the majority of them were between 10–30 years of age. The results of the questionnaire assessment indicated that 13.8% of the respondents did not receive treatment in 2017 for various reasons, the most prominent among them being “absence/travel” (37.1%). Data in the registers were used to verify the treatment coverage for the years 2017 and 2018, and reviewed against the reported coverage obtained from the district. Significant differences between the reported and verified coverages were only observed in four communities. However, the assessment also revealed that the reported coverage was only accurate in 33.3% of cases. Conclusions The MDA registers allow for the identification of eligible individuals who were not reached during any MDA round. Thus, the MDA registers could be utilized at the community and programme levels to identify missing and untreated individuals, appropriately address their non-compliance to MDA, and thereby improve MDA coverage in each implementation unit and monitor the progress towards elimination of LF. The challenges observed through the review of the registers also offer opportunities to improve the training given to the community drug distributors. Elephantiasis is a disease that is common in Ghana. Since the year 2000 the country has implemented a control programme aimed at eliminating the disease as a public health problem, through the yearly treatment of entire communities in districts where the disease is found. Achievements have been made, and treatment has stopped in many districts; however, some districts have received many years of treatment without successfully reducing the infections below the targeted levels. Many individuals go untreated every year, as can be observed from the low reported treatment coverage after MDA. This untreated population may explain why some districts have failed to achieve the criteria for stopping treatment. Fortunately, the treatments are recorded in community registers, which contain the details of all community members, as well as their treatment participation. These registers can therefore be used to identify people who have not received treatment and design appropriate interventions to reach them. Through these registers, we were able to identify and characterize individuals who were not treated between 2016 and 2018 in 10 communities. We found that 4 out of 10 people missed at least one treatment between 2016 and 2018, and the majority of them were 10–30 years of age. Using the information from the registers we were also able to verify the proportion of people who took part in the treatments in 2017 and 2018, and compared this to what was reported. This comparison revealed that the reporting was only accurate in 33% of cases. A questionnaire was also used to cross-check the participation of study participants in the 2017 MDA, with results indicating that 13.8% of the respondents did not receive treatment for various reasons, the most prominent among them being “absence/travel” (37.1%). Although these registers are seldom used by the Lymphatic Filariasis Control Programme for anything other than recording and reporting treatment information, this study shows that the registers provide an opportunity to identify individuals who have not received treatment, develop a plan to appropriately address their reasons for not taking part in the treatments, target these untreated individuals to improve the overall proportion of people taking part in MDA, and assess the accuracy of reported coverage information. These activities will allow the programme to better monitor the progress towards, and ultimately achieve, elimination of lymphatic filariasis as a public health problem.
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Affiliation(s)
- Dziedzom K. de Souza
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon-Accra, Ghana
- * E-mail:
| | - Katherine Gass
- Task Force for Global Health, Decatur, Georgia, United States of America
| | - Joseph Otchere
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon-Accra, Ghana
| | - Ye Min Htet
- Task Force for Global Health, Decatur, Georgia, United States of America
- Emory University, Atlanta, Georgia, United States of America
| | - Odame Asiedu
- Neglected Tropical Diseases Programme, Ghana Health Service, Accra, Ghana
| | - Benjamin Marfo
- Neglected Tropical Diseases Programme, Ghana Health Service, Accra, Ghana
| | - Nana-Kwadwo Biritwum
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Daniel A. Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon-Accra, Ghana
| | - Collins S. Ahorlu
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon-Accra, Ghana
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Luna F, Luyckx VA. Why have Non-communicable Diseases been Left Behind? Asian Bioeth Rev 2020; 12:5-25. [PMID: 33717328 DOI: 10.1007/s41649-020-00112-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Non-communicable diseases are no longer largely limited to high-income countries and the elderly. The burden of non-communicable diseases is rising across all country income categories, in part because these diseases have been relatively overlooked on the global health agenda. Historically, communicable diseases have been prioritized in many countries as they were perceived to constitute the greatest disease burden, especially among vulnerable and poor populations, and strategies for prevention and treatment, which had been successful in high-income settings, were considered feasible and often affordable in low-income settings. This prioritization has reduced the communicable diseases burden globally but has left non-communicable diseases largely neglected. A new approach is urgently needed to tackle non-communicable diseases. Based on an analysis of potential features which may have underlain the different approaches to non-communicable diseases and communicable diseases until now, including acuity of disease, potential for control or cure, cost, infectiousness, blaming of individuals and logistical barriers, little ethical or rational justification can be found to support continued neglect of non-communicable diseases. Justice demands access to quality and affordable care for all. An equitable approach to non-communicable diseases is therefore strongly mandated on medical, ethical, economic, and public health grounds. Funding must not however be diverted away from communicable diseases, which continue to require attention-but concomitantly, funding for non-communicable diseases must be increased. International and multi-sectoral action is required to accelerate progress towards true universal health coverage and towards achievement of all of the sustainable development goals, such that prevention and access to care for non-communicable disease can become a global reality.
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Affiliation(s)
- Florencia Luna
- Programa de Bioética, Área Ética, Derechos y Bienes Públicos Globales, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Buenos Aires, Argentina
| | - Valerie A Luyckx
- Institute for Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
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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.
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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
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Chami GF, Bundy DAP. More medicines alone cannot ensure the treatment of neglected tropical diseases. THE LANCET. INFECTIOUS DISEASES 2019; 19:e330-e336. [PMID: 31160190 DOI: 10.1016/s1473-3099(19)30160-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/15/2019] [Accepted: 03/13/2019] [Indexed: 01/19/2023]
Abstract
Neglected tropical diseases afflict more than 1 billion of the world's poorest people. Pharmaceutical donations of preventive chemotherapy for neglected tropical diseases enable the largest en masse treatment campaigns globally with respect to the number of people targeted for treatment. However, the blanket distribution of medicines at no cost to individuals in need of treatment does not guarantee that those individuals are treated. In this Personal View, we aim to examine the next steps that need to be taken towards ensuring equitable treatment access, including health system integration and the role of endemic countries in ensuring medicines are delivered to patients. We argue that the expansion of medicine donation programmes and the development of new medicines are not the primary solutions to sustaining and expanding the growth of neglected tropical disease programmes. Treatment is often not verified by a medical professional, independent surveyor, or national programme officer. Additionally, access to medicines might not be equitable across at-risk populations, and treatment targets for disease control remain largely unmet within many endemic countries. To enable equitable access and efficient use of existing medicines, research is needed now on how best to integrate the treatment of neglected tropical diseases into local health systems. A comprehensive approach should be used, which combines mass drug administration with on-demand access to treatment. Increased commitment by endemic countries, when possible, around the ownership of treatment campaigns is essential to improve access to medicines for neglected tropical diseases.
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Affiliation(s)
- Goylette F Chami
- Department of Pathology, University of Cambridge, Cambridge, UK.
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