An ecosystem approach to malaria control in an urban setting

Malaria and fish farming in the Brazilian Amazon Region: a strengths, weaknesses, opportunities, and threats analysis

INTRODUCTION

The fish farming program in Acre is as an alternative program to generate income and employment and has promising regional, national, and international markets. While the economic importance of fish farming in the Jurua Region is clear, one must address its contribution to increase malaria transmission.

METHODS

This was a qualitative study. The answers of the 16 key informants were organized into the following: (1) the healthcare services structure; (2) conscience, perception, and behaviors; and (3) socioeconomic and political issues. Each answer was classified as weaknesses, strengths, opportunities, and threats.

RESULTS

Regarding healthcare services, the frequency of household visits was reduced, and subjects presenting with malaria symptoms were required to visit a healthcare unit to be diagnosed and treated. Regarding individual's conscience, perception, and behavior, malaria was considered an insignificant disease, and a large proportion of the population were engaged in health practices that put them at risk in contacting with malaria vectors. Regarding political and economic issues, there were economic and infrastructure barriers for the development of a productive activity, and the insufficient credit or formalization of their properties prevented their access to governmental incentives and the financial market.

CONCLUSIONS

Support to fish farmers for low-cost inputs was not observed, and appropriate knowledge regarding the impact of the absence of maintenance and abandonment of fish tanks was insufficient. Moreover, insufficient healthcare services prevented not only the treatment of individuals with malaria but also the control of this disease.

Addressing vulnerability, building resilience: community-based adaptation to vector-borne diseases in the context of global change

Background

The threat of a rapidly changing planet – of coupled social, environmental and climatic change – pose new conceptual and practical challenges in responding to vector-borne diseases. These include non-linear and uncertain spatial-temporal change dynamics associated with climate, animals, land, water, food, settlement, conflict, ecology and human socio-cultural, economic and political-institutional systems. To date, research efforts have been dominated by disease modeling, which has provided limited practical advice to policymakers and practitioners in developing policies and programmes on the ground.

Main body

In this paper, we provide an alternative biosocial perspective grounded in social science insights, drawing upon concepts of vulnerability, resilience, participation and community-based adaptation. Our analysis was informed by a realist review (provided in the Additional file 2) focused on seven major climate-sensitive vector-borne diseases: malaria, schistosomiasis, dengue, leishmaniasis, sleeping sickness, chagas disease, and rift valley fever. Here, we situate our analysis of existing community-based interventions within the context of global change processes and the wider social science literature. We identify and discuss best practices and conceptual principles that should guide future community-based efforts to mitigate human vulnerability to vector-borne diseases. We argue that more focused attention and investments are needed in meaningful public participation, appropriate technologies, the strengthening of health systems, sustainable development, wider institutional changes and attention to the social determinants of health, including the drivers of co-infection.

Conclusion

In order to respond effectively to uncertain future scenarios for vector-borne disease in a changing world, more attention needs to be given to building resilient and equitable systems in the present.

Electronic supplementary material

The online version of this article (doi: 10.1186/s40249-017-0375-2) contains supplementary material, which is available to authorized users.

First Record of Triatoma maculata (Erichson, 1848) (Hemiptera: Reduviidae: Triatomini) in the Municipality of Riohacha, La Guajira - Colombia

Introduction: Knowledge of vector insect species, their habitat, and geographical distribution is crucial for determining the risk of transmission of the etiological agents that cause disease in humans, which allows defining strategies for prevention, surveillance, and control in line with the characteristics of each area.

Objective: To determine the presence and public health importance of vectors of Chagas disease in the indigenous settlements of Marbacella and El Horno of the Wayúu ethnic group in the municipality of Riohacha, La Guajira, Colombia.

Materials and Methods: From active search, installation and inspection of biosensors, and occasional catches, Hemiptera: Reduviidae: Triatomini were collected intra and in the peridomicile housing of the indigenous settlements of El Horno and Marbacella of the Wayúu ethnic group. Indices of intra and peridomestic infestation, colonization, density, dispersion, and natural infection with Trypanosoma cruzi Chagas, 1909 were calculated.

Results: 79.6% (n = 90) of the specimens were collected in the peridomicile and 20.3% (n = 23) in the intradomicile, all corresponding to Triatoma maculata (Erichson, 1848). The natural infection indices with T. cruzi accounted for 43.5% for Marbacella and 36% for El Horno.

Conclusion: This is the first reported capture of individuals of T. maculata, considered a secondary vector of Chagas disease in Colombia, naturally infected with T. cruzi in the municipality of Riohacha expanding the geographical distribution of the species in the department of La Guajira.

Collaboration between local health and local government agencies for health improvement

BACKGROUND

In many countries, national, regional and local inter- and intra-agency collaborations have been introduced to improve health outcomes. Evidence is needed on the effectiveness of locally developed partnerships which target changes in health outcomes and behaviours.

OBJECTIVES

To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes in any population or age group.

SEARCH METHODS

We searched the Cochrane Public Health Group Specialised Register, AMED, ASSIA, CENTRAL, CINAHL, DoPHER, EMBASE, ERIC, HMIC, IBSS, MEDLINE, MEDLINE In-Process, OpenGrey, PsycINFO, Rehabdata, Social Care Online, Social Services Abstracts, Sociological Abstracts, TRoPHI and Web of Science from 1966 through to January 2012. 'Snowballing' methods were used, including expert contact, citation tracking, website searching and reference list follow-up.

SELECTION CRITERIA

Randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs) and interrupted time series (ITS) where the study reported individual health outcomes arising from interagency collaboration between health and local government agencies compared to standard care. Studies were selected independently in duplicate, with no restriction on population subgroup or disease.

DATA COLLECTION AND ANALYSIS

Two authors independently conducted data extraction and assessed risk of bias for each study.

MAIN RESULTS

Sixteen studies were identified (28,212 participants). Only two were considered to be at low risk of bias. Eleven studies contributed data to the meta-analyses but a narrative synthesis was undertaken for all 16 studies. Six studies examined mental health initiatives, of which one showed health benefit, four showed modest improvement in one or more of the outcomes measured but no clear overall health gain, and one showed no evidence of health gain. Four studies considered lifestyle improvements, of which one showed some limited short-term improvements, two failed to show health gains for the intervention population, and one showed more unhealthy lifestyle behaviours persisting in the intervention population. Three studies considered chronic disease management and all failed to demonstrate health gains. Three studies considered environmental improvements and adjustments, of which two showed some health improvements and one did not.Meta-analysis of three studies exploring the effect of collaboration on mortality showed no effect (pooled relative risk of 1.04 in favour of control, 95% CI 0.92 to 1.17). Analysis of five studies (with high heterogeneity) looking at the effect of collaboration on mental health resulted in a standardised mean difference of -0.28, a small effect favouring the intervention (95% CI -0.51 to -0.06). From two studies, there was a statistically significant but clinically modest improvement in the global assessment of function symptoms score scale, with a pooled mean difference (on a scale of 1 to 100) of -2.63 favouring the intervention (95% CI -5.16 to -0.10).For physical health (6 studies) and quality of life (4 studies) the results were not statistically significant, the standardised mean differences were -0.01 (95% CI -0.10 to 0.07) and -0.08 (95% CI -0.44 to 0.27), respectively.

AUTHORS' CONCLUSIONS

Collaboration between local health and local government is commonly considered best practice. However, the review did not identify any reliable evidence that interagency collaboration, compared to standard services, necessarily leads to health improvement. A few studies identified component benefits but these were not reflected in overall outcome scores and could have resulted from the use of significant additional resources. Although agencies appear enthusiastic about collaboration, difficulties in the primary studies and incomplete implementation of initiatives have prevented the development of a strong evidence base. If these weaknesses are addressed in future studies (for example by providing greater detail on the implementation of programmes; using more robust designs, integrated process evaluations to show how well the partners of the collaboration worked together, and measurement of health outcomes) it could provide a better understanding of what might work and why. It is possible that local collaborative partnerships delivering environmental Interventions may result in health gain but the evidence base for this is very limited.Evaluations of interagency collaborative arrangements face many challenges. The results demonstrate that collaborative community partnerships can be established to deliver interventions but it is important to agree goals, methods of working, monitoring and evaluation before implementation to protect programme fidelity and increase the potential for effectiveness.

Comprehensive primary health care in South America: contexts, achievements and policy implications

This article summarizes an extensive review of South American experiences with primary health care since the Declaration of Alma-Ata. It aims to address the following specific questions: What are the enabling and constraining historical and structural conditions for primary health care policies and practices? How has health care reform supported or undermined primary health care? What evidence exists on the effectiveness of primary health care? What strategies are common to best practices? What evidence exists on the roles of citizen participation and intersectoral action? And finally, what are the policy lessons to be learned from these experiences? Narrative synthesis was used to identify and examine patterns in the data consistent with these questions. Conditions that were found to promote successful implementation of primary health care are outlined, together with features of effective primary health care systems that help create more equitable health services and health outcomes.

Collaboration between local health and local government agencies for health improvement

BACKGROUND

In many countries, national, regional and local inter- and intra-agency collaborations have been introduced in order to improve health outcomes. Evidence is needed on the effectiveness of locally-developed partnerships which target changes in individual health outcomes and behaviours.

OBJECTIVES

To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes.

SEARCH STRATEGY

Twenty-five databases were searched using a highly sensitive search strategy. 'Snowballing' methods were also used, including expert contact, website searching and reference list follow up.

SELECTION CRITERIA

Randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs) and interrupted time series (ITS) where the study reported on interagency collaboration between health and local government agencies. Studies were selected independently in duplicate by two of five authors.

DATA COLLECTION AND ANALYSIS

From the team of five review authors, two authors independently conducted data extraction and assessed risk of bias for each study.

MAIN RESULTS

Eleven studies were identified, presenting information on a total of 26,686 participants. Owing to the heterogeneity between studies a narrative synthesis was undertaken. The included studies covered a range of topics. Six studies examined mental health initiatives, of which one study showed health benefit; four showed modest improvement in one or more of the outcomes measured, but no clear overall health gain; and one study showed no evidence of health gain. Two studies were related to lifestyle improvements of which one failed to show health gains for the intervention population, while the other showed more unhealthy lifestyle behaviours persisting in the intervention population. Three studies were related to chronic disease management and all three failed to demonstrate health gains.

AUTHORS' CONCLUSIONS

Collaboration between local health and local government is commonly considered best practice. However, the review did not identify any reliable evidence that inter‑agency collaboration, compared to standard services, leads to health improvement. A few studies identified component benefits but these were not reflected in overall outcome scores and could have resulted from the use of significant additional resources. Although agencies appear enthusiastic about collaboration, methodological flaws in the primary studies and incomplete implementation of initiatives have prevented the development of a strong evidence base. If these flaws are addressed in future studies (for example by providing greater detail on the implementation of programs, using more robust designs, with integrated process evaluations and measurement of health outcomes) it could provide a better understanding of what might work and why.When updating this review, we will analyse any partnership or process evaluations of our included studies to try to identify markers of success in local collaborative partnerships that could inform policy developments in the future.

Ecosystem approaches and health in Latin America

Important environmental changes that have become increasingly pronounced in the last two centuries and that are seriously affecting human health require the development of integrated and participatory scientific approaches that can result in proposals for institutional and public policy changes. The purpose of this article is to offer some elements that can contribute to a line of reflection based on studies with ecosystem approaches in the Latin America context. The authors begin with a brief description of current scientific literature in public health that links ecosystems and human health in Latin America; next, they describe and compare the two prevailing trends that form the basis for the theoretical and methodological debates on ecosystem approaches; they also review the empirical research in Latin America or concerning Latin American countries in which an ecosystem approach has been adopted. The results point to limited scientific output on the interface between ecosystems and human health; aspects involving public participation and implementation of institutional changes and public policies are still in a rather incipient stage.

Community based vector control in Malindi, Kenya

BACKGROUND

Community involvement has become an important component of the National Malaria Control Strategy in Kenya, resulting in the organization of groups charged with addressing mosquito and malaria-related concerns within the community.

OBJECTIVES

The purpose of this study was to identify community groups involved with intended malaria vector control activity in Malindi, Kenya.

METHODS

Information was obtained from key informant interviews, focus group discussions, and a stakeholder meeting. The objectives were to determine the roles of community groups, identify examples of past successes and obstacles to successful implementation of vector control, and assess the level of knowledge about malaria and mosquitoes among the groups.

RESULTS

Nineteen of 34 community groups (56%) registered at social services reported intended malaria vector control activities such as treating ditches, making and selling insecticide-treated mosquito nets, draining stagnant water, organizing clean-ups, making and selling neem soap, and the organization of campaigns such as the "Malaria Mosquito Day". Major challenges facing these groups include volunteerism, lack of technical expertise, supervision, and maintaining control activities in the absence of funds. Most groups reported limited knowledge about malaria vectors, and thus targeted all water bodies for control activities.

CONCLUSIONS

We found that community groups are willing to participate in control operations, but lack government and technical support. We highlight the importance of strengthening organizational efforts and capacity building, as well as the need to clarify government policy on malaria vector control responsibilities within the communities.