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Ikejezie J, Langley T, Lewis S, Bisanzio D, Phalkey R. The epidemiology of diphtheria in Haiti, December 2014–June 2021: A spatial modeling analysis. PLoS One 2022; 17:e0273398. [PMID: 35994502 PMCID: PMC9394811 DOI: 10.1371/journal.pone.0273398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Haiti has been experiencing a resurgence of diphtheria since December 2014. Little is known about the factors contributing to the spread and persistence of the disease in the country. Geographic information systems (GIS) and spatial analysis were used to characterize the epidemiology of diphtheria in Haiti between December 2014 and June 2021. Methods Data for the study were collected from official and open-source databases. Choropleth maps were developed to understand spatial trends of diphtheria incidence in Haiti at the commune level, the third administrative division of the country. Spatial autocorrelation was assessed using the global Moran’s I. Local indicators of spatial association (LISA) were employed to detect areas with spatial dependence. Ordinary least squares (OLS) and geographically weighted regression (GWR) models were built to identify factors associated with diphtheria incidence. The performance and fit of the models were compared using the adjusted r-squared (R2) and the corrected Akaike information criterion (AICc). Results From December 2014 to June 2021, the average annual incidence of confirmed diphtheria was 0.39 cases per 100,000 (range of annual incidence = 0.04–0.74 per 100,000). During the study period, diphtheria incidence presented weak but significant spatial autocorrelation (I = 0.18, p<0.001). Although diphtheria cases occurred throughout Haiti, nine communes were classified as disease hotspots. In the regression analyses, diphtheria incidence was positively associated with health facility density (number of facilities per 100,000 population) and degree of urbanization (proportion of urban population). Incidence was negatively associated with female literacy. The GWR model considerably improved model performance and fit compared to the OLS model, as indicated by the higher adjusted R2 value (0.28 v 0.15) and lower AICc score (261.97 v 267.13). Conclusion This study demonstrates that GIS and spatial analysis can support the investigation of epidemiological patterns. Furthermore, it shows that diphtheria incidence exhibited spatial variability in Haiti. The disease hotspots and potential risk factors identified in this analysis could provide a basis for future public health interventions aimed at preventing and controlling diphtheria transmission.
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Affiliation(s)
- Juniorcaius Ikejezie
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Tessa Langley
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Donal Bisanzio
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- RTI International, Washington, District of Columbia, United States of America
| | - Revati Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Climate Change and Health Unit, UK Health Security Agency, London, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Chênes C, Albert H, Kao K, Ray N. Use of Physical Accessibility Modelling in Diagnostic Network Optimization: A Review. Diagnostics (Basel) 2022; 12:diagnostics12010103. [PMID: 35054270 PMCID: PMC8774366 DOI: 10.3390/diagnostics12010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Diagnostic networks are complex systems that include both laboratory-tested and community-based diagnostics, as well as a specimen referral system that links health tiers. Since diagnostics are the first step before accessing appropriate care, diagnostic network optimization (DNO) is crucial to improving the overall healthcare system. The aim of our review was to understand whether the field of DNO, and especially route optimization, has benefited from the recent advances in geospatial modeling, and notably physical accessibility modeling, that have been used in numerous health systems assessment and strengthening studies. All publications published in English between the journal’s inception and 12 August 2021 that dealt with DNO, geographical accessibility and optimization, were systematically searched for in Web of Science and PubMed, this search was complemented by a snowball search. Studies from any country were considered. Seven relevant publications were selected and charted, with a variety of geospatial approaches used for optimization. This paucity of publications calls for exploring the linkage of DNO procedures with realistic accessibility modeling framework. The potential benefits could be notably better-informed travel times of either the specimens or population, better estimates of the demand for diagnostics through realistic population catchments, and innovative ways of considering disease epidemiology to inform DNO.
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Affiliation(s)
- Camille Chênes
- Institute for Environmental Sciences, University of Geneva, 1205 Geneva, Switzerland;
| | | | | | - Nicolas Ray
- Institute for Environmental Sciences, University of Geneva, 1205 Geneva, Switzerland;
- GeoHealth Group, Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-379-07-84
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Moran ZR, Frimpong AB, Castañeda-Casado P, Frimpong FK, de Lorenzo MB, Ben Amor Y. Tropical Laboratory Initiative: An innovative model for laboratory medicine in rural areas. Afr J Lab Med 2019; 8:922. [PMID: 31616619 PMCID: PMC6779993 DOI: 10.4102/ajlm.v8i1.922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/12/2019] [Indexed: 11/01/2022] Open
Abstract
Background Communities in rural, low-resource settings often lack access to reliable diagnostics. This leads to missed and misdiagnosed cases of disease and contributes to morbidity and mortality. Objective This paper describes a model for providing local laboratory services to rural areas of Ghana, and provides suggestions on how it could be adapted and expanded to serve populations in a range of rural communities. Methods The Tropical Laboratory Initiative (TLI) system in Ghana comprises one central laboratory where samples delivered from clinics by motorbike riders are analysed. Test requests and results are communicated on a mHealth application, and the patient does not have to visit the laboratory or travel beyond the clinic to receive a test. The TLI also serves as a research base. The laboratory is accredited by the National Health Insurance Authority, and accepts the national health insurance. The TLI serves several communities in Amansie West, Ashanti region, and currently works with 10 clinics. The nearest hospital is a one-hour drive away and is the only other nearby facility for diagnostics beyond basic rapid tests. Results Demand for services has increased yearly since the launch in 2010, and the TLI currently provides over 1000 tests to approximately 350 patients monthly. The majority of patients are female, and the most common tests are for antenatal care. Our experience demonstrates that laboratory services can be affordable and most components already exist, even in rural areas. Conclusion Ministries of health in low-resource settings should consider this model to complement the rapid tests available in clinics. Integrating with an insurance system promotes financial sustainability.
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Affiliation(s)
- Zelda R Moran
- Earth Institute, Columbia University, New York, New York, United States
| | | | | | | | | | - Yanis Ben Amor
- Center for Sustainable Development, Earth Institute, Columbia University, New York, New York, United States
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Standley CJ, Muhayangabo R, Bah MS, Barry AM, Bile E, Fischer JE, Heegaard W, Koivogui L, Lakiss SK, Sorrell EM, VanSteelandt A, Dahourou AG, Martel LD. Creating a National Specimen Referral System in Guinea: Lessons From Initial Development and Implementation. Front Public Health 2019; 7:83. [PMID: 31111025 PMCID: PMC6499205 DOI: 10.3389/fpubh.2019.00083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/26/2019] [Indexed: 11/21/2022] Open
Abstract
In the wake of the 2014–2016, West Africa Ebola virus disease (EVD) outbreak, the Government of Guinea recognized an opportunity to strengthen its national laboratory system, incorporating capacity and investments developed during the response. The Ministry of Health (MOH) identified creation of a holistic, safe, secure, and timely national specimen referral system as a priority for improved detection and confirmation of priority diseases, in line with national Integrated Disease Surveillance and Response guidelines. The project consisted of two parts, each led by different implementing partners working collaboratively together and with the Ministry of Health: the development and approval of a national specimen referral policy, and pilot implementation of a specimen referral system, modeled on the policy, in three prefectures. This paper describes the successful execution of the project, highlighting the opportunities and challenges of building sustainable health systems capacity during and after public health emergencies, and provides lessons learned for strengthening national capabilities for surveillance and disease diagnosis.
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Affiliation(s)
- Claire J Standley
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
| | | | | | - Alpha M Barry
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
| | - Ebi Bile
- US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Julie E Fischer
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
| | | | | | | | - Erin M Sorrell
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
| | | | - Anicet G Dahourou
- US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lise D Martel
- US Centers for Disease Control and Prevention, Atlanta, GA, United States
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McBain RK, Jerome G, Leandre F, Browning M, Warsh J, Shah M, Mistry B, Faure PAI, Pierre C, Fang AP, Mugunga JC, Gottlieb G, Rhatigan J, Kaplan R. Activity-based costing of health-care delivery, Haiti. Bull World Health Organ 2018; 96:10-17. [PMID: 29403096 PMCID: PMC5791872 DOI: 10.2471/blt.17.198663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Methods Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Findings Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Conclusion Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.
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Affiliation(s)
- Ryan K McBain
- Partners In Health, 800 Boylston Street, Suite 1400, Boston, Massachusetts, United States of America (USA)
| | | | | | - Micaela Browning
- Partners In Health, 800 Boylston Street, Suite 1400, Boston, Massachusetts, United States of America (USA)
| | | | | | | | | | - Claire Pierre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | - Jean Claude Mugunga
- Partners In Health, 800 Boylston Street, Suite 1400, Boston, Massachusetts, United States of America (USA)
| | - Gary Gottlieb
- Partners In Health, 800 Boylston Street, Suite 1400, Boston, Massachusetts, United States of America (USA)
| | - Joseph Rhatigan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Jean Louis F, Buteau J, Boncy J, Anselme R, Stanislas M, Nagel MC, Juin S, Charles M, Burris R, Antoine E, Yang C, Kalou M, Vertefeuille J, Marston BJ, Lowrance DW, Deyde V. Building and Rebuilding: The National Public Health Laboratory Systems and Services Before and After the Earthquake and Cholera Epidemic, Haiti, 2009-2015. Am J Trop Med Hyg 2017; 97:21-27. [PMID: 29064354 PMCID: PMC5676632 DOI: 10.4269/ajtmh.16-0941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Before the 2010 devastating earthquake and cholera outbreak, Haiti’s public health laboratory systems were weak and services were limited. There was no national laboratory strategic plan and only minimal coordination across the laboratory network. Laboratory capacity was further weakened by the destruction of over 25 laboratories and testing sites at the departmental and peripheral levels and the loss of life among the laboratory health-care workers. However, since 2010, tremendous progress has been made in building stronger laboratory infrastructure and training a qualified public health laboratory workforce across the country, allowing for decentralization of access to quality-assured services. Major achievements include development and implementation of a national laboratory strategic plan with a formalized and strengthened laboratory network; introduction of automation of testing to ensure better quality of results and diversify the menu of tests to effectively respond to outbreaks; expansion of molecular testing for tuberculosis, human immunodeficiency virus, malaria, diarrheal and respiratory diseases; establishment of laboratory-based surveillance of epidemic-prone diseases; and improvement of the overall quality of testing. Nonetheless, the progress and gains made remain fragile and require the full ownership and continuous investment from the Haitian government to sustain these successes and achievements.
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Affiliation(s)
| | - Josiane Buteau
- National Public Health Laboratory, Government of Haiti, Port-au-Prince, Haiti
| | - Jacques Boncy
- National Public Health Laboratory, Government of Haiti, Port-au-Prince, Haiti
| | - Renette Anselme
- National Public Health Laboratory, Government of Haiti, Port-au-Prince, Haiti
| | - Magalie Stanislas
- National Public Health Laboratory, Government of Haiti, Port-au-Prince, Haiti
| | - Mary C Nagel
- National Public Health Laboratory, Government of Haiti, Port-au-Prince, Haiti
| | - Stanley Juin
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | - Robert Burris
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Eva Antoine
- U.S. Agency for International Development, Port-au-Prince, Haiti
| | - Chunfu Yang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mireille Kalou
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - David W Lowrance
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Varough Deyde
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
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Roberts T, Cohn J, Bonner K, Hargreaves S. Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges. Clin Infect Dis 2016; 62:1043-8. [PMID: 26743094 PMCID: PMC4803106 DOI: 10.1093/cid/ciw001] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/23/2015] [Indexed: 01/27/2023] Open
Abstract
Despite immense progress in antiretroviral therapy (ART) scale-up, many people still lack access to basic standards of care, with our ability to meet the Joint United Nations Programme on HIV/AIDS 90-90-90 treatment targets for HIV/AIDS dependent on dramatic improvements in diagnostics. The World Health Organization recommends routine monitoring of ART effectiveness using viral load (VL) testing at 6 months and every 12 months, to monitor treatment adherence and minimize failure, and will publish its VL toolkit later this year. However, the cost and complexity of VL is preventing scale-up beyond developed countries and there is a lack of awareness among clinicians as to the long-term patient benefits and its role in prolonging the longevity of treatment programs. With developments in this diagnostic field rapidly evolving-including the recent improvements for accurately using dried blood spots and the imminent appearance to the market of point-of-care technologies offering decentralized diagnosis-we describe current barriers to VL testing in resource-limited settings. Effective scale-up can be achieved through health system and laboratory system strengthening and test price reductions, as well as tackling multiple programmatic and funding challenges.
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Affiliation(s)
| | | | | | - Sally Hargreaves
- International Health Unit, Department of Medicine, Section of Infectious Diseases and Immunity, Imperial College London, United Kingdom
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