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Win Han Oo, Kaung Myat Thu, Cutts JC, Win Htike, Kyawt Mon Win, May Chan Oo, Galau NH, Agius PA, Pyae Phyo Htoon, Kearney E, Aung Thi, Ye Win Aung, Min Min Thein, Rosecrans K, Kyi Tun Lwin, Aung Kyi Min, Fowkes FJI. Sustainability of a mobile phone application-based data reporting system in Myanmar's malaria elimination program: a qualitative study. BMC Med Inform Decis Mak 2021; 21:285. [PMID: 34663306 PMCID: PMC8521268 DOI: 10.1186/s12911-021-01646-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
Background Strengthening surveillance systems to collect near-real-time case-based data plays a fundamental role in achieving malaria elimination in the Greater Mekong Subregion (GMS). With the advanced and widespread use of digital technology, mHealth is increasingly taking a prominent role in malaria surveillance systems in GMS countries, including Myanmar. In Myanmar’s malaria elimination program, an mHealth system called Malaria Case-based Reporting (MCBR) has been applied for case-based reporting of malaria data by integrated community malaria volunteers (ICMVs). However, the sustainability of such mHealth systems in the context of existing malaria elimination programs in Myanmar is unknown.
Methods Focus group discussions were conducted with ICMVs and semi-structured in-depth interviews were conducted with malaria program stakeholders from Myanmar’s Ministry of Health and Sports and its malaria program implementing partners. Thematic (deductive followed by inductive) analysis was undertaken using a qualitative descriptive approach.
Results Technological and financial constraints such as inadequate internet access, software errors, and insufficient financial resources to support mobile phone-related costs have hampered users’ access to MCBR. Poor system integrity, unpredictable reporting outcomes, inadequate human resources for system management, and inefficient user support undermined the perceived quality of the system and user satisfaction, and hence its sustainability. Furthermore, multiple parallel systems with functions overlapping those of MCBR were in use. Conclusions Despite its effectiveness and efficiency in malaria surveillance, the sustainability of nationwide implementation of MCBR is uncertain. To make it sustainable, stakeholders should deploy a dedicated human workforce with the necessary technical and technological capacities; secure sustainable, long-term funding for implementation of MCBR; find an alternative cost-effective plan for ensuring sustainable system access by ICMVs, such as using volunteer-owned mobile phones for reporting rather than supporting new mobile phones to them; and find a solution to the burden of multiple parallel systems. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01646-z.
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Affiliation(s)
- Win Han Oo
- Disease Elimination Program, Burnet Institute, Melbourne, Australia. .,Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar.
| | - Kaung Myat Thu
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
| | - Julia C Cutts
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Win Htike
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
| | - Kyawt Mon Win
- National Malaria Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - May Chan Oo
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
| | - Naw Hkawng Galau
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
| | - Paul A Agius
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Ellen Kearney
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Aung Thi
- National Malaria Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Ye Win Aung
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
| | | | | | - Kyi Tun Lwin
- Save the Children International, Yangon, Myanmar
| | - Aung Kyi Min
- Save the Children International, Yangon, Myanmar
| | - Freya J I Fowkes
- Disease Elimination Program, Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Win Han Oo, Win Htike, Cutts JC, Kyawt Mon Win, Kaung Myat Thu, May Chan Oo, Galau Naw Hkawng, Agius PA, Pyae Phyo Htoon, Scott N, Kearney E, Moreira C, Pedrana A, Stoove M, Aung Thi, Ye Win Aung, Min Min Thein, Rosecrans K, Kyi Tun Lwin, Aung Kyi Min, Fowkes FJI. A mobile phone application for malaria case-based reporting to advance malaria surveillance in Myanmar: a mixed methods evaluation. Malar J 2021; 20:167. [PMID: 33771144 PMCID: PMC7995396 DOI: 10.1186/s12936-021-03701-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To achieve malaria elimination in the Greater Mekong Subregion, including Myanmar, it is necessary to ensure all malaria cases are detected, treated, and reported in a timely manner. Mobile phone-based applications for malaria reporting, case management, and surveillance implemented at a community-level may overcome reporting limitations associated with current paper-based reporting (PBR), but their effectiveness in this context is unknown. METHODS A mixed methods evaluation study was undertaken to determine the effectiveness of a national Malaria Case-Based Reporting (MCBR) mobile phone application in improving malaria case reporting compared to the existing PBR reporting system in Myanmar. Methods included secondary analysis of malaria case report data, questionnaires, focus group discussions and field observations of community volunteers, interviews and direct observations of malaria programme stakeholders, and cost analysis. Using a combination of these approaches the following areas were investigated: data quality and completeness, data access and usage, capacity for timely reporting, the acceptability, functionality, and ease of use of the application and facilitators and barriers to its use, and the relative cost of MCBR compared to the PBR system. RESULTS Compared to PBR, MCBR enabled more accurate and complete data to be reported in a much timelier manner, with 63% of MCBR users reporting they transmit rapid diagnostic test outcomes within 24 h, compared to 0% of PBR users. MCBR was favoured by integrated community malaria volunteers and their supervisors because of its efficiency. However, several technical and operational challenges associated with internet coverage, data transmission, and e-literacy were identified and stakeholders reported not being confident to rely solely on MCBR data for programmatic decision-making. CONCLUSIONS Implementation of MCBR provided timely and accurate data for malaria surveillance. Findings from this evaluation study will enable the optimization of an application-based reporting system for malaria monitoring and surveillance in the Greater Mekong Subregion and advance systems to track progress towards, and certify, the achievement of malaria elimination targets.
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Affiliation(s)
| | - Win Htike
- Burnet Institute, Melbourne, Australia
| | - Julia C Cutts
- Burnet Institute, Melbourne, Australia.,Department of Medicine, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Kyawt Mon Win
- National Malaria Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | | | | | - Paul A Agius
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia
| | | | - Nick Scott
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia
| | | | | | - Alisa Pedrana
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Aung Thi
- National Malaria Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | | | | | | | | | - Freya J I Fowkes
- Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Gamboa-León R, Ramirez-Gonzalez C, Pacheco-Tucuch FS, O'Shea M, Rosecrans K, Pippitt J, Dumonteil E, Buekens P. Seroprevalence of Trypanosoma cruzi among mothers and children in rural Mayan communities and associated reproductive outcomes. Am J Trop Med Hyg 2014; 91:348-53. [PMID: 24935948 DOI: 10.4269/ajtmh.13-0527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our objective was to determine the seroprevalence of Trypanosoma cruzi infection among mothers and children in two rural Mayan communities in Yucatan, Mexico and examine sociodemographic characteristics and adverse reproductive outcomes associated with maternal infection. We performed household surveys in the communities of Sudzal and Teya. Mothers were interviewed, and blood samples were obtained to perform rapid tests and enzyme-linked immunosorbent assays (ELISAs). We surveyed 390 mothers and 685 children. The overall seroprevalence was 2.3% among mothers and 0.4% among children. In Sudzal, we found a seroprevalence of 4.4% among mothers and 0.7% in children. In Teya, we found a seroprevalence of 0.9% among mothers and 0.3% among children. Compared with uninfected mothers, seropositive mothers reported more stillbirths (relative risk = 4.7; 95% confidence interval = 2.1-10.4). T. cruzi infection is present in these communities, and infected children indicate active transmission. Seropositivity in mothers is associated with a history of adverse reproductive outcomes.
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Affiliation(s)
- Rubi Gamboa-León
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Claudia Ramirez-Gonzalez
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Freddy S Pacheco-Tucuch
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Matthew O'Shea
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Kathryn Rosecrans
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Julia Pippitt
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Eric Dumonteil
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Pierre Buekens
- Laboratorio de Parasitología, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, México; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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Rosecrans K, Cruz-Martin G, King A, Dumonteil E. Opportunities for improved chagas disease vector control based on knowledge, attitudes and practices of communities in the yucatan peninsula, Mexico. PLoS Negl Trop Dis 2014; 8:e2763. [PMID: 24676038 PMCID: PMC3967964 DOI: 10.1371/journal.pntd.0002763] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 02/14/2014] [Indexed: 11/19/2022] Open
Abstract
Background Chagas disease is a vector-borne parasitic disease of major public health importance. Current prevention efforts are based on triatomine vector control to reduce transmission to humans. Success of vector control interventions depends on their acceptability and value to affected communities. We aimed to identify opportunities for and barriers to improved vector control strategies in the Yucatan peninsula, Mexico. Methodology/principal findings We employed a sequence of qualitative and quantitative research methods to investigate knowledge, attitudes and practices surrounding Chagas disease, triatomines and vector control in three rural communities. Our combined data show that community members are well aware of triatomines and are knowledgeable about their habits. However, most have a limited understanding of the transmission dynamics and clinical manifestations of Chagas disease. While triatomine control is not a priority for community members, they frequently use domestic insecticide products including insecticide spray, mosquito coils and plug-in repellents. Families spend about $32 US per year on these products. Alternative methods such as yard cleaning and window screens are perceived as desirable and potentially more effective. Screens are nonetheless described as unaffordable, in spite of a cost comparable to the average annual spending on insecticide products. Conclusion/Significance Further education campaigns and possibly financing schemes may lead families to redirect their current vector control spending from insecticide products to window screens. Also, synergism with mosquito control efforts should be further explored to motivate community involvement and ensure sustainability of Chagas disease vector control. Chagas disease is an important parasitic disease transmitted by triatomine bugs. Current prevention efforts are based on eliminating triatomines from homes to reduce disease transmission to humans. However, the success of these control interventions depends on their acceptability and value to affected communities. We aimed to identify opportunities for and barriers to triatomine control strategies in the Yucatan peninsula, Mexico. We used a sequence of group discussion, interviews, and a survey to investigate the perception and knowledge of communities on Chagas disease and triatomines in three villages from the Yucatan peninsula, Mexico. Inhabitants are rather familiar with triatomine bugs, but do not associate well these bugs with Chagas disease and its clinical manifestations. Mosquito rather than triatomine control is a common preoccupation, and households frequently use insecticide spray, mosquito coils and plug-in repellents, spending about $32 US per year on these products. Alternative methods such as yard cleaning and window screens are perceived as desirable and potentially more effective. Screens are nonetheless described as unaffordable. The promotion of education campaigns and possibly financing schemes could help families to redirect their current spending from insecticide products to window screens. Also, synergism with mosquito control efforts should be further explored to motivate community involvement and ensure sustainability of Chagas disease vector control.
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Affiliation(s)
- Kathryn Rosecrans
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Gabriela Cruz-Martin
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Ashley King
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
- Department of International Health, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Eric Dumonteil
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail: ,
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Dumonteil E, Nouvellet P, Rosecrans K, Ramirez-Sierra MJ, Gamboa-León R, Cruz-Chan V, Rosado-Vallado M, Gourbière S. Eco-bio-social determinants for house infestation by non-domiciliated Triatoma dimidiata in the Yucatan Peninsula, Mexico. PLoS Negl Trop Dis 2013; 7:e2466. [PMID: 24086790 PMCID: PMC3784500 DOI: 10.1371/journal.pntd.0002466] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/23/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chagas disease is a vector-borne disease of major importance in the Americas. Disease prevention is mostly limited to vector control. Integrated interventions targeting ecological, biological and social determinants of vector-borne diseases are increasingly used for improved control. METHODOLOGY/PRINCIPAL FINDINGS We investigated key factors associated with transient house infestation by T. dimidiata in rural villages in Yucatan, Mexico, using a mixed modeling approach based on initial null-hypothesis testing followed by multimodel inference and averaging on data from 308 houses from three villages. We found that the presence of dogs, chickens and potential refuges, such as rock piles, in the peridomicile as well as the proximity of houses to vegetation at the periphery of the village and to public light sources are major risk factors for infestation. These factors explain most of the intra-village variations in infestation. CONCLUSIONS/SIGNIFICANCE These results underline a process of infestation distinct from that of domiciliated triatomines and may be used for risk stratification of houses for both vector surveillance and control. Combined integrated vector interventions, informed by an Ecohealth perspective, should aim at targeting several of these factors to effectively reduce infestation and provide sustainable vector control.
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Affiliation(s)
- Eric Dumonteil
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Pierre Nouvellet
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
- UMR 5244 CNRS-UPVD ‘Ecologie et Evolution des Interactions’, Université de Perpignan Via Domitia, Perpignan, France
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Kathryn Rosecrans
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Maria Jesus Ramirez-Sierra
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Rubi Gamboa-León
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Vladimir Cruz-Chan
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Miguel Rosado-Vallado
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Sébastien Gourbière
- UMR 5244 CNRS-UPVD ‘Ecologie et Evolution des Interactions’, Université de Perpignan Via Domitia, Perpignan, France
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