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Aranda Z. A Community Health Worker Day in Rural Chiapas, Mexico, in a Nutshell. Am J Trop Med Hyg 2024:tpmd230727. [PMID: 38593791 DOI: 10.4269/ajtmh.23-0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico/Compañeros En Salud, Chiapas, México
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Aranda Z, Caamal V, Montaño M, Bernal D, Meneses S. Exploring how non-clinical factors in childbirth care shape users' experiences in public health facilities in rural Chiapas, Mexico: a qualitative study using the WHO health systems responsiveness framework. BMC Pregnancy Childbirth 2024; 24:173. [PMID: 38424565 PMCID: PMC10905866 DOI: 10.1186/s12884-024-06357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Many Mexicans face barriers to receive delivery care from qualified professionals, especially indigenous and poor sectors of the population, which represent most of the population in the state of Chiapas. When access to institutional delivery care is an option, experiences with childbirth care are often poor. This underscores the need for evidence to improve the quality of services from the user's perspective. The present study was conceived with the objective of understanding how non-clinical aspects of care shape women's birthing experiences in public health institutions in Chiapas. METHODS We conducted an exploratory qualitative study. Data collection consisted in 20 semi-structured interviews to women who had delivered in a public health facility in Chiapas during the last six months prior to the interview. For the design of the interview guide we used the WHO health system responsiveness framework, which focus on the performance of the health system in terms of the extent to which it delivers services according to the "universally legitimate expectations of individuals" and focuses on the non-financial and non-clinical qualities of care. The resulting data were analyzed using thematic analysis methodology. RESULTS We identified a total of 16 themes from the data, framed in eight categories which followed the eight domains of the WHO health systems responsiveness framework: Choice of the provider and the facility, prompt attention, quality of basic amenities, access to social support, respectful treatment, privacy, involvement in decisions, and communication. We shed light on the barriers women face in receiving prompt care, aspects of health facilities that impact women's comfort, the relevance of being provided with adequate food and drink during institutional delivery, how accompaniment contributes positively to the birthing experience, the aspects of childbirth that women find important to decide on, and how providers' interpersonal behaviors affect the birthing experience. CONCLUSIONS We have identified non-clinical aspects of childbirth care that are important to the user experience and that are not being satisfactorily addressed by public health institutions in Chiapas. This evidence constitutes a necessary first step towards the design of strategies to improve the responsiveness of the Chiapas health system in childbirth care.
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Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México.
| | - Viviana Caamal
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México
| | - Mariana Montaño
- Partners In Health Mexico (Compañeros En Salud), Ángel Albino Corzo, Calle Primera Pte. Sur 25, Colonia Centro, 30370 Ángel Albino Corzo, Chiapas, México
| | - Daniel Bernal
- Escuela de Gobierno y Transformación Pública, Instituto Tecnológico y de Estudios Superiores de Monterrey, Ciudad de México, México
| | - Sergio Meneses
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, México
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Aranda Z, Vázquez S, Gopaluni A, Martínez L, Ramírez M, Jiménez A, Bernal D, Rodríguez AL, Chacón S, Vargas B, Fulcher IR, Barnhart DA. Evaluation of the implementation of a community health worker-led COVID-19 contact tracing intervention in Chiapas, Mexico, from March 2020 to December 2021. BMC Health Serv Res 2024; 24:97. [PMID: 38233915 PMCID: PMC10795220 DOI: 10.1186/s12913-024-10590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES's implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. METHODS Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. RESULTS From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). CONCLUSIONS Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy.
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Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México.
- Departamento de Salud, El Colegio de La Frontera Sur, San Cristóbal de Las Casas, Chiapas, México.
| | - Sandra Vázquez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Anuraag Gopaluni
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Mayra Ramírez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Ariwame Jiménez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Daniel Bernal
- Escuela de Gobierno y Transformación Pública, Instituto Tecnológico de Monterrey, Ciudad de Mexico, México
| | - Ana L Rodríguez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
- Instituto Nacional de Salud Pública/Escuela de Salud Pública de México, Cuernavaca, Morelos, México
| | - Selene Chacón
- Instituto Nacional de Salud Pública/Escuela de Salud Pública de México, Cuernavaca, Morelos, México
| | - Bruno Vargas
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Isabel R Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Harvard Data Science Initiative, Boston, MA, USA
| | - Dale A Barnhart
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health Rwanda (Inshuti Mu Buzima), Kigali, Rwanda
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Fejfar D, Andom AT, Msuya M, Jeune MA, Lambert W, Varney PF, Aron MB, Connolly E, Juárez A, Aranda Z, Niyigena A, Cubaka VK, Boima F, Reed V, Law MR, Grépin KA, Mugunga JC, Hedt-Gauthier B, Fulcher I. The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries. Glob Health Action 2023; 16:2178604. [PMID: 36880985 PMCID: PMC10013493 DOI: 10.1080/16549716.2023.2178604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes. OBJECTIVE We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses. METHODS We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker. RESULTS For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: -5.1%, -1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning. CONCLUSIONS Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.
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Affiliation(s)
| | - Afom T Andom
- Clinical Services, Partners In Health, Maseru, Lesotho
| | - Meba Msuya
- Clinical Services, Partners In Health, Maseru, Lesotho
| | - Marc Antoine Jeune
- Department of Strategic Planning and Information Systems, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Wesler Lambert
- Department of Strategic Planning and Information Systems, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Prince F Varney
- Strategic Health Information Systems, Partners In Health, Monrovia, Liberia
| | - Moses Banda Aron
- Monitoring, Evaluation, and Information, Partners In Health, Neno, Malawi
| | - Emilia Connolly
- Monitoring, Evaluation, and Information, Partners In Health, Neno, Malawi
| | - Ameyalli Juárez
- Partners In Health/Compañeros en Salud, Jaltenango de la Paz, Mexico
| | - Zeus Aranda
- Partners In Health/Compañeros en Salud, Jaltenango de la Paz, Mexico
| | - Anne Niyigena
- Department of Research and Training, Partners In Health, Kigali, Rwanda
| | - Vincent K Cubaka
- Department of Research and Training, Partners In Health, Kigali, Rwanda
| | - Foday Boima
- Strategic Health Informations Systems, Partners In Health, Koidu City, Kono District, Sierra Leone
| | - Vicky Reed
- Strategic Health Informations Systems, Partners In Health, Koidu City, Kono District, Sierra Leone
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Karen A Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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de Lourdes Arrieta-Canales M, Mukherjee J, Gilbert H, Flores H, Muñoz M, Aranda Z, DiChiara S, Noya C. Transforming care for patients living with diabetes in rural Mexico: a qualitative study of patient and provider experiences and perceptions of shared medical appointments. Glob Health Action 2023; 16:2215004. [PMID: 37254880 DOI: 10.1080/16549716.2023.2215004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Global prevalence of diabetes is increasing, causing widespread morbidity, mortality and increased healthcare costs. Providing quality care in a timely fashion to people with diabetes in low-resource settings can be challenging. In the underserved state of Chiapas, Mexico, which has some of the lowest diabetes detection and control rates in the country, there is a need to implement strategies that improve care for patients with diabetes. One such strategy is shared medical appointments (SMAs), a patient-centred approach that has proven effective in fostering patient engagement and comprehensive care delivery among underserved populations. OBJECTIVE This study aimed to understand the perceptions, experiences and insights of both patients living with diabetes and healthcare providers, who took part in a pilot SMA strategy implemented in five outpatient clinics in rural Chiapas. METHODS Following an exploratory qualitative approach, we conducted 50 in-depth interviews with patients and providers involved in diabetes SMAs and five focus group discussions with community health workers providing patient support and education. RESULTS The implementation of an SMA model changed how diabetes care is perceived, structured and delivered. Patients felt sheltered by group interactions based on trust, which allowed for the exchange of experiences, learning and increased engagement in treatment and lifestyle changes. Providers gained insights into their patients' context and lived experiences, which resulted in improved rapport and quality of care. SMAs also restructured some operational aspects in the clinics and fostered the sharing of power and responsibilities amongst the staff. CONCLUSIONS The SMAs model transformed care by providing a patient-centred, collaborative approach to diabetes care, education and support. Additionally, it reshaped the health-care team resulting in power-shifting and role-sharing among members of the interdisciplinary team. We therefore encourage decision-makers to expand the use of SMAs to improve care for patients with diabetes in low-resource settings.
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Affiliation(s)
- Martha de Lourdes Arrieta-Canales
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Primary Care, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, Mexico
| | - Joia Mukherjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Hannah Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Hugo Flores
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Brigham and Woman's Hospital, Boston, MA, USA
- Partners In Health, Boston, MA, USA
| | - Melania Muñoz
- Department of Primary Care, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, Mexico
| | - Zeus Aranda
- Department of Primary Care, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, Mexico
- El Colegio de la Frontera Sur, San Cristóbal de las Casas, Chiapas Mexico
| | - Samuel DiChiara
- Department of Primary Care, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, Mexico
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Carolina Noya
- Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA
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Ballard M, Olaniran A, Iberico MM, Rogers A, Thapa A, Cook J, Aranda Z, French M, Olsen HE, Haughton J, Lassala D, Carpenter Westgate C, Malitoni B, Juma M, Perry HB. Labour conditions in dual-cadre community health worker programmes: a systematic review. Lancet Glob Health 2023; 11:e1598-e1608. [PMID: 37734803 DOI: 10.1016/s2214-109x(23)00357-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/23/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Health care delivered by community health workers reduces morbidity and mortality while providing a considerable return on investment. Despite growing consensus that community health workers, a predominantly female workforce, should receive a salary, many community health worker programmes take the form of dual-cadre systems, where a salaried cadre of community health workers works alongside a cadre of unsalaried community health workers. We aimed to determine the presence, prevalence, and magnitude of exploitation in national dual-cadre programmes. METHODS We did a systematic review of available evidence from peer-reviewed databases and grey literature from database inception to Aug 2, 2021, for studies on unsalaried community health worker cadres in dual-cadre systems. Editorials, protocols, guidelines, or conference reports were excluded in addition to studies about single-tier community health worker programmes and those reporting on only salaried cadres of community health workers in a dual-cadre system. We extracted data on remuneration, workload, task complexity, and self-reported experiences of community health workers. Three models were created: a minimum model with the shortest time and frequency per task documented in the literature, a maximum model with the longest time, and a median model. Labour exploitation was defined as being engaged in work below the country's minimum wage together with excessive work hours or complex tasks. The study was registered with PROSPERO, CRD42021271500. FINDINGS We included 117 reports from 112 studies describing community health workers in dual-cadre programmes across 19 countries. The majority of community health workers were female. 13 (59%) of 22 unsalaried community health worker cadres and one (10%) of ten salaried cadres experienced labour exploitation. Three (17%) of 18 unsalaried community health workers would need to work more than 40 h per week to fulfil their assigned responsibilities. Unsalaried community health worker cadres frequently reported non-payment, inadequate or inconsistent payment of incentives, and an overburdensome workload. INTERPRETATION Unsalaried community health workers in dual-cadre programmes often face labour exploitation, potentially leading to inadequate health-care provision. Labour laws must be upheld and the creation of professional community health worker cadres with fair contracts prioritised, international funding allocated to programmes that rely on unsalaried workers should be transparently reported, the workloads of community health workers should be modelled a priori and actual time use routinely assessed, community health workers should have input in policies that affect them, and volunteers should not be responsible for the delivery of essential health services. FUNDING None.
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Affiliation(s)
- Madeleine Ballard
- Community Health Impact Coalition, London, UK; Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - M Matías Iberico
- Partners in Health Mexico, Ángel Albino Corzo, México; Tulane University School of Medicine, New Orleans, LA, USA
| | - Ash Rogers
- Lwala Community Alliance, Nashville, TN, USA
| | | | | | - Zeus Aranda
- Partners in Health Mexico, Ángel Albino Corzo, México; El Colegio de la Frontera Sur, San Cristóbal de las Casas, México
| | | | | | - Jessica Haughton
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Rodríguez-Cuevas F, Maza-Colli J, Montaño-Sosa M, de Lourdes Arrieta-Canales M, Aristizabal-Hoyos P, Aranda Z, Flores-Navarro H. Promoting Patient-Centered Health Care and Health Equity through Health Professionals' Education in Rural Chiapas. Health Hum Rights 2023; 25:119-131. [PMID: 37266313 PMCID: PMC9973509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Since 2011, the nongovernmental organization Compañeros En Salud, as Partners In Health is known in Mexico, has worked in collaboration with the Mexican Ministry of Health to strengthen the health care system in the Fraylesca and Sierra Mariscal regions of Chiapas, Mexico. In response to the high proportion of abandoned and understaffed clinics in the area, Compañeros En Salud has developed a program to entice medical students from some of the top medical schools in Mexico to spend their "social service year" in these facilities, where they receive financial support, on-site clinical mentoring, supplies, clinical support tools, and training in global health and social medicine using a structural competency framework. The idea is to provide high-quality health care to a historically underserved population through a lens of health as a human right. Although other structurally competent global health curricula have been implemented worldwide, primarily in the Global North, the Compañeros En Salud model is unique in that it combines (1) the facilitation of theoretical lectures based on the Social Medicine Consortium's definition of social medicine, (2) global health case discussion and context-reflective experiential simulations, and (3) exposure to patients who suffer the burden of structural injustice. In this paper, we describe the motivations behind the training model, its holistic approach, and the impact of this initiative after a decade of implementation.
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Affiliation(s)
- Fátima Rodríguez-Cuevas
- Mental health coordinator at Compañeros En Salud/Partners In Health Mexico and an alumnus of the HEAL Initiative Fellowship, San Francisco, United States
| | - Jimena Maza-Colli
- Clinical and teaching director at Compañeros En Salud/Partners In Health Mexico
| | - Mariana Montaño-Sosa
- Sexual and reproductive health coordinator at Compañeros En Salud/Partners In Health Mexico and an alumnus of the HEAL Initiative Fellowship, San Francisco, United States
| | | | - Patricia Aristizabal-Hoyos
- Professor at the Faculty of Higher Studies Iztacala at the National Autonomous University of Mexico, Mexico City, Mexico
| | - Zeus Aranda
- Research and impact intern at Compañeros En Salud/Partners In Health Mexico and a visiting scholar at El Colegio de la Frontera Sur, Chiapas, Mexico
| | - Hugo Flores-Navarro
- Board member of Compañeros En Salud/Partners In Health Mexico and appointed faculty in the Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States
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Rodríguez AL, Aranda Z, Brun E, DiChiara S, Esquinca A, González E, González S, Jiménez A, Molina-Orozco CU, Martínez L, Mullen J, Vargas B, Vázquez S, Chacón-Hernández S. A comprehensive and healthcare equity promoting response by a civil society-public partnership to COVID-19 in Chiapas, Mexico. BMJ Glob Health 2023; 8:bmjgh-2022-011244. [PMID: 36941004 PMCID: PMC10030274 DOI: 10.1136/bmjgh-2022-011244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/22/2023] [Indexed: 03/23/2023] Open
Abstract
Following the first COVID-19 case in Chiapas, Mexico in March 2020, the non-governmental organisation Compañeros En Salud (CES) and the state's Ministry of Health (MOH) decided to join forces to respond to the global pandemic. The collaboration was built over 8 years of partnership to bring healthcare to underserved populations in the Sierra Madre region. The response consisted of a comprehensive SARS-CoV-2 infection prevention and control programme, which included prevention through communication campaigns to combat misinformation and stigma related to COVID-19, contact tracing of suspected and confirmed COVID-19 cases and their contacts, outpatient and inpatient care for patients with respiratory symptoms, and CES-MOH collaboration on anti-COVID-19 immunisation campaigns. In this article, we describe these interventions and their principal outcomes, as well as reflect on notable pitfalls identified during the collaboration, and we suggest a series of recommendations to prevent and mitigate their occurrence. As with many cities and towns across the globe, the poor preparedness of the local health system for a pandemic and pandemic response led to the collapse of the medical supply chain, the saturation of public medical facilities and the exhaustion of healthcare personnel, which had to be overcome through adaptation, collaboration and innovation. For our programme in particular, the lack of a formal definition of roles and clear lines of communication between CES and the MOH; thoughtful planning, monitoring and evaluation and active engagement of the communities served in the design and implementation of health interventions affected the outcomes of our efforts.
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Affiliation(s)
- Ana Laura Rodríguez
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Zeus Aranda
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Departamento de Salud, El Colegio de la Frontera Sur, San Cristobal de las Casas, Mexico
| | - Elvire Brun
- Compañeros En Salud, Ángel Albino Corzo, Mexico
| | - Samuel DiChiara
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Tulane University, New Orleans, Louisiana, USA
| | | | - Erick González
- Secretaria de Salud del Estado de Chiapas, Ángel Albino Corzo, Mexico
- Brandeis University, Waltham, Massachusetts, USA
| | - Sebastián González
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | | | | | - Laura Martínez
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Socios En Salud Sucursal Peru, Lima, Peru
| | | | | | | | - Selene Chacón-Hernández
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Instituto Nacional de Salud Publica, Cuernavaca, Mexico
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Aranda Z, Sánchez-Pérez HJ. The need to address the impact of COVID-19 on TB control for vulnerable groups. Public Health Action 2022; 12:147. [PMID: 36160720 PMCID: PMC9484590 DOI: 10.5588/pha.22.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Z. Aranda
- Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, México, Departamento de Salud, El Colegio de la Frontera Sur, San Cristóbal de las Casas, México
| | - H. J. Sánchez-Pérez
- Departamento de Salud, El Colegio de la Frontera Sur, San Cristóbal de las Casas, México, Grup de Recerca d’Amèrica i Àfrica Llatines, Cerdanyola del Vallés, Catalunya, Spain
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Gutiérrez-Peláez K, Aranda Z, Jiménez-Peña A, Mata-González H. How inequity threatens the lives of pregnant women: barriers to accessing health services during an incomplete miscarriage in rural southern Mexico. BMJ Case Rep 2022; 15:15/5/e248819. [PMID: 35606027 PMCID: PMC9174763 DOI: 10.1136/bcr-2022-248819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Globally, obstetric emergencies majorly account for maternal morbidity and mortality. Guerrero, Oaxaca and Chiapas accounted for more than 13% of maternal deaths in the country in 2021. Obstetric haemorrhage was the leading cause of maternal death after COVID-19 infection and hypertensive disorders. This case highlights the clinical course and social determinants of health that limited access to health services in a young woman with an obstetric emergency in rural southern Mexico. The case describes common challenges during an obstetric emergency in resource-poor settings, such as timely referral to a second level of care. Our analysis identifies the social determinants of health behind the slow and inadequate emergency response. Additionally, we present several interventions that can be implemented in low-resource settings for strengthening the response to obstetric emergencies at the primary and secondary levels of care.
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Affiliation(s)
- Karen Gutiérrez-Peláez
- Programa de Médico Cirujano, Escuela de Medicina y Ciencias de la Salud del Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Nuevo León, México
| | - Zeus Aranda
- Programa de Investigación e Impacto, Partners In Health México/Compañeros En Salud, Ángel Albino Corzo, Chiapas, México
- Departamento de Salud, El Colegio de la Frontera Sur, San Cristóbal de las Casas, Chiapas, México
| | - Andrea Jiménez-Peña
- Programa Multicéntrico de Especialidades Médicas, Escuela de Medicina y Ciencias de la Salud del Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Nuevo León, México
| | - Hellen Mata-González
- Programa de Salud Sexual y Reproductiva, Partners In Health México/Compañeros En Salud, Ángel Albino Corzo, Chiapas, México
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11
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Aranda Z, Binde T, Tashman K, Tadikonda A, Mawindo B, Maweu D, Boley EJ, Mphande I, Dumbuya I, Montaño M, Clisbee M, Mvula MG, Ndayizigiye M, Casella Jean-Baptiste M, Varney PF, Anyango S, Grépin KA, Law MR, Mugunga JC, Hedt-Gauthier B, Fulcher IR. Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries. BMJ Glob Health 2022; 7:bmjgh-2021-007247. [PMID: 35012970 PMCID: PMC8753094 DOI: 10.1136/bmjgh-2021-007247] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [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: 08/24/2021] [Accepted: 12/10/2021] [Indexed: 01/01/2023] Open
Abstract
The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.
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Affiliation(s)
- Zeus Aranda
- Compañeros En Salud/Partners In Health-Mexico, Ángel Albino Corzo, Mexico
| | - Thierry Binde
- Partners In Health-Sierra Leone, Koidu, Sierra Leone
| | - Katherine Tashman
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Data Science Initiative, Boston, Massachusetts, USA
| | - Ananya Tadikonda
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bill Mawindo
- Partners In Health-Sierra Leone, Koidu, Sierra Leone
| | | | | | - Isaac Mphande
- Abwenzi Pa Za Umoyo/Partners In Health-Malawi, Neno, Malawi
| | - Isata Dumbuya
- Partners In Health-Sierra Leone, Koidu, Sierra Leone
| | - Mariana Montaño
- Compañeros En Salud/Partners In Health-Mexico, Ángel Albino Corzo, Mexico
| | - Mary Clisbee
- Zanmi Lasante/Partners In Health-Haiti, Croix-des-Bouquets, Haiti
| | | | | | | | | | | | - Karen Ann Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Michael R Law
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Claude Mugunga
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Partners In Health, Boston, Massachusetts, USA
| | - Bethany Hedt-Gauthier
- Harvard Medical School, Boston, Massachusetts, USA.,Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Isabel R Fulcher
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Data Science Initiative, Boston, Massachusetts, USA
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12
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Ortega AC, Valtierra E, Rodríguez-Cuevas FG, Aranda Z, Preciado G, Mohar S. Protecting vulnerable communities and health professionals from COVID-19 associated mental health distress: a comprehensive approach led by a public-civil partnership in rural Chiapas, Mexico. Glob Health Action 2021; 14:1997410. [PMID: 34889715 PMCID: PMC8667903 DOI: 10.1080/16549716.2021.1997410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has stricken mental health worldwide. Marginalized populations in low- and middle-income countries have been the most affected, as they were already experiencing barriers to accessing mental health care prior to the pandemic and are unequally exposed to the stressors associated with the health emergency, such as economic ravages or increased risk of complicated disease outcomes. OBJECTIVE The aim of this paper is to describe a comprehensive initiative resulting from a public-civil partnership to address the increased burden of mental health illness associated with the COVID-19 pandemic in rural Chiapas, Mexico. METHODS To address the emerging health needs of the general population and health professionals resulting from the pandemic, Compañeros En Salud (CES), a non-profit civil society organization based in Chiapas, implemented a comprehensive strategy to compensate for the shortage of mental health services in the region in collaboration with the Chiapas Ministry of Health. The strategy included three components: capacity building in mental health care delivery, psychosocial support to the general population, and provision of mental health care to CES collaborating staff. In this capacity building article, implementers from CES and the government share descriptive information on the specific interventions carried out and their beneficiaries, as well as a critical discussion of the strategy followed. RESULTS Through this strategy, we have been successful in filling the gaps in the public health system to ensure that CES-served populations and CES-collaborating health professionals have access to mental health care. However, further studies to quantify the impact of this intervention in alleviating the burden of mental health illnesses associated with the pandemic are needed. CONCLUSIONS The current situation represents an opportunity to reimagine global mental health. Only through the promotion of community-based initiatives and the development of integrated approaches will we ensure the well-being of marginalized populations.
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Affiliation(s)
- Ana Cecilia Ortega
- Mental Health Program, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, México
| | - Erika Valtierra
- Mental Health Program, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, México
| | - Fátima Gabriela Rodríguez-Cuevas
- Mental Health Program, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, México
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Zeus Aranda
- Research and Impact Program, Partners in Health Mexico/Compañeros En Salud, Ángel Albino Corzo, México
| | - Gisela Preciado
- Mental Health Program, Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, México
| | - Sebastián Mohar
- Hospital Básico Comunitario de Ángel Albino Corzo, Chiapas Ministry of Health, Ángel Albino Corzo, México
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13
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Aranda Z, Arana-Cedeño M, Meléndez-Navarro DM, Meneses-Navarro S, Sánchez-Pérez HJ. A call for COVID-19 immunization campaigns that address the specific circumstances of indigenous peoples of Latin America and the Caribbean. ACTA ACUST UNITED AC 2021; 3:100074. [PMID: 34522915 PMCID: PMC8430228 DOI: 10.1016/j.lana.2021.100074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, Chiapas, México
| | - Marcos Arana-Cedeño
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.,Centro de Capacitación en Ecología y Salud Para Campesinos y Defensoría del Derecho a La Salud, San Cristóbal de las Casas, Chiapas, México
| | | | - Sergio Meneses-Navarro
- CONACYT/Center for Health Systems Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, México
| | - Héctor Javier Sánchez-Pérez
- Grup de Recerca d'Amèrica i Àfrica Llatines, Cerdanyola del Vallés, Catalunya, Espanya.,El Colegio de la Frontera Sur, San Cristóbal de Las Casas, Chiapas, México
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14
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Aranda Z, Fulcher IR, Hedt-Gauthier B, Mugunga JC, Binde T. COVID-19 and maternal and perinatal outcomes. Lancet Glob Health 2021; 9:e1065. [PMID: 34297959 PMCID: PMC8294003 DOI: 10.1016/s2214-109x(21)00297-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, Chiapas 30370, México.
| | - Isabel R Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Harvard Data Science Initiative, Boston, MA, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jean Claude Mugunga
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Thierry Binde
- Partners In Health Sierra Leone, Koidu, Kono, Sierra Leone
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15
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Affiliation(s)
- Zeus Aranda
- Research and Impact Programme, Partners in Health Mexico (Compañeros En Salud), Ángel Albino Corzo 30370, Chiapas, Mexico.
| | - Fátima Gabriela Rodríguez-Cuevas
- Mental Health Programme, Partners in Health Mexico (Compañeros En Salud), Ángel Albino Corzo 30370, Chiapas, Mexico; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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16
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Aranda Z, Vargas B, Jiménez A. A local response to a global problem: a programme to combat COVID-19 through empowerment of rural communities in Chiapas, Mexico. The Lancet Global Health 2021. [DOI: 10.1016/s2214-109x(21)00112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Bakare AA, Graham H, Agwai IC, Shittu F, King C, Colbourn T, Iuliano A, Aranda Z, McCollum ED, Isah A, Bahiru S, Valentine P, Falade AG, Burgess RA. Community and caregivers' perceptions of pneumonia and care-seeking experiences in Nigeria: A qualitative study. Pediatr Pulmonol 2020; 55 Suppl 1:S104-S112. [PMID: 31985894 DOI: 10.1002/ppul.24620] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Appropriate and timely care seeking can reduce pneumonia deaths, but are influenced by caregivers and community norms of health and illness. We explore caregiver and community perceptions, and care-seeking experience, of childhood pneumonia, to understand contexts that drive pediatric service uptake in Nigeria. METHODS Community group discussions and qualitative interviews with caregivers in Lagos and Jigawa states were completed between 1 November 2018 and 31 May 2019. Participants were recruited from purposively sampled health facility catchment areas with assistance from facility staff. We used episodic interviews, asking caregivers (Jigawa = 20; Lagos = 15) to recount specific events linked to quests for therapy. Community group discussions (n = 3) used four vignettes from real pneumonia cases to frame a discussion around community priorities for healthcare and community-led activities to improve child survival. Data were analyzed using the framework method. RESULTS We found poor knowledge of pneumonia-specific symptoms and risk factors among caregivers and community members, with many attributing pneumonia to cold air exposure. Interviews highlighted that care-seeking decision making involved both husbands and wives, but men often made final decisions. In Lagos, older female relatives also shaped quests for therapy. Cost was a major consideration. In both states, there were accounts of dissatisfaction with health workers' attitudes and a general acceptance of vaccination services. CONCLUSION There is a need for community-based approaches to improve caregiver knowledge and care seeking for under-five children with pneumonia. Messaging should attend to knowledge of symptoms, risk factors, family dynamics, and community responsibilities in healthcare service delivery and utilization.
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Affiliation(s)
- Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria.,Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Hamish Graham
- Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Imaria C Agwai
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Funmilayo Shittu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Institute for Global Health, University College London, London, UK
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Agnese Iuliano
- Institute for Global Health, University College London, London, UK
| | - Zeus Aranda
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Eudowood Division of Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | | | | | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.,Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
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18
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King C, Iuliano A, Burgess RA, Agwai I, Ahmar S, Aranda Z, Bahiru S, Bakare AA, Colbourn T, Shittu F, Graham H, Isah A, McCollum ED, Falade AG. A mixed-methods evaluation of stakeholder perspectives on pediatric pneumonia in Nigeria-priorities, challenges, and champions. Pediatr Pulmonol 2020; 55 Suppl 1:S25-S33. [PMID: 31985139 DOI: 10.1002/ppul.24607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/28/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Interventions to reduce pneumonia mortality exist; however, stakeholder engagement is needed to prioritize these. We explored diverse stakeholder opinions on current policy challenges and priorities for pediatric pneumonia in Nigeria. METHODS We conducted a mixed-methods study, with a web-survey and semi-structured interviews, to explore stakeholder roles, policy barriers, opportunities, and priorities. Web-survey participants were identified through stakeholder mapping, including researchers' networks, academic and grey literature, and "Every Breath Counts" coalition membership. Stakeholders included actors involved in pediatric pneumonia in Nigeria from non-governmental, government, academic, civil society, private, and professional organizations. Stakeholder interviews were conducted with local government, healthcare managers, professional associations, and local leaders in Lagos and Jigawa states. Quantitative data were analyzed descriptively; qualitative data were analyzed using a thematic framework. RESULTS Of 111 stakeholders, 38 (34%) participated in the web-survey and 18 stakeholder interviews were conducted. Four thematic areas emerged: current policy, systems barriers, intervention priorities, and champions. Interviewees reported a lack of pneumonia-specific policies, despite acknowledging guidelines had been adopted in their settings. Barriers to effective pneumonia management were seen at all levels of the system, from the community to healthcare to policy, with key issues of resourcing and infrastructure. Intervention priorities were the strengthening of community knowledge and improving case management, focused on primary care. While stakeholders identified several key actors for pediatric pneumonia, they also highlighted a lack of champions. CONCLUSION Consistent messages emerged to prioritize community and primary care initiatives, alongside improved access to oxygen, and pulse oximetry. There is a need for clear pneumonia policies, and support for adoption at a state level.
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Affiliation(s)
- Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Institute for Global Health, University College London, London, UK
| | - Agnese Iuliano
- Institute for Global Health, University College London, London, UK
| | | | - Imaria Agwai
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Zeus Aranda
- Institute for Global Health, University College London, London, UK
| | | | - Ayobami A Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Funmilayo Shittu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hamish Graham
- International Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Adegoke G Falade
- Department of Paediatrics, University of Ibadan and University College Hospital, Ibadan, Nigeria
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19
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Shittu F, Agwai IC, Falade AG, Bakare AA, Graham H, Iuliano A, Aranda Z, McCollum ED, Isah A, Bahiru S, Ahmed T, Burgess RA, King C, Colbourn T, On Behalf Of The Inspiring Project Consortium. Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria. Pediatr Pulmonol 2020; 55 Suppl 1:S78-S90. [PMID: 31990146 PMCID: PMC7977681 DOI: 10.1002/ppul.24660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Case fatality rates for childhood pneumonia in Nigeria remain high. There is a clear need for improved case management of pneumonia, through the sustainable implementation of the Integrated Management of Childhood Illnesses (IMCI) diagnostic and treatment algorithms. We explored barriers and opportunities for improved case management of childhood pneumonia in Lagos and Jigawa states, Nigeria. METHODS A mixed-method analysis was conducted to assess the current health system capacity to deliver quality care. This was done through audits of 16 facilities in Jigawa and 14 facilities in Lagos, questionnaires (n = 164) and 13 focus group discussions with providers. Field observations provided context for data analysis and triangulation. RESULTS There were more private providers in Lagos (4/8 secondary facilities) and more government providers in Jigawa (4/8 primary, 3/3 secondary, and 1/1 tertiary facilities). Oxygen and pulse oximeters were available in two of three in Jigawa and six of eight in Lagos of the sampled secondary care facilities. None of the eight primary facilities surveyed in Jigawa had oxygen or pulse oximetry available while in Lagos two of three primary facilities had oxygen and one of three had pulse oximeters. Other IMCI and emergency equipment were also lacking including respiratory rate timers, particularly in Jigawa state. Health care providers scored poorly on knowledge of IMCI, though previous IMCI training was associated with better knowledge. Key enabling factors in delivering pediatric care highlighted by health care providers included accountability procedures and feedback loops, the provision of free medication for children, and philanthropic acts. Common barriers to provide care included the burden of out-of-pocket payments, challenges in effective communication with caregivers, delayed presentation, and lack of clear diagnosis, and case management guidelines. CONCLUSION There is an urgent need to improve how the prevention and treatment of pediatric pneumonia is directed in both Lagos and Jigawa. Priority areas for reducing pediatric pneumonia burden are training and mentoring of health care providers, community health education, and introduction of oximeters and oxygen supply.
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Affiliation(s)
- Funmilayo Shittu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Imaria C Agwai
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Hamish Graham
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Agnese Iuliano
- Institute for Global Health, University College London, London, UK
| | - Zeus Aranda
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | | | | | | | - Carina King
- Institute for Global Health, University College London, London, UK.,Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
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20
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Iuliano A, Aranda Z, Colbourn T, Agwai IC, Bahiru S, Bakare AA, Burgess RA, Cassar C, Shittu F, Graham H, Isah A, McCollum ED, Falade AG, King C, On Behalf Of The Inspiring Project Consortium. The burden and risks of pediatric pneumonia in Nigeria: A desk-based review of existing literature and data. Pediatr Pulmonol 2020; 55 Suppl 1:S10-S21. [PMID: 31985170 DOI: 10.1002/ppul.24626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/22/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pneumonia is a leading killer of children under-5 years, with a high burden in Nigeria. We aimed to quantify the regional burden and risks of pediatric pneumonia in Nigeria, and specifically the states of Lagos and Jigawa. METHODS We conducted a scoping literature search for studies of pneumonia morbidity and mortality in under-5 children in Nigeria from 10th December 2018 to 26th April 2019, searching: Cochrane, PubMed, and Web of Science. We included grey literature from stakeholders' websites and information shared by organizations working in Nigeria. We conducted multivariable logistic regression using the 2016 to 2017 Multiple Cluster Indicators Survey data set to explore factors associated with pneumonia. Descriptive analyses of datasets from 2010 to 2019 was done to estimate trends in mortality, morbidity, and vaccination coverage. RESULTS We identified 25 relevant papers (10 from Jigawa, 8 from Lagos, and 14 national data). None included data on pneumonia or acute respiratory tract infection burden in the health system, inpatient case-fatality rates, severity, or age-specific pneumonia mortality rates at state level. Secondary data analysis found that no household or caregiver socioeconomic indicators were consistently associated with self-reported symptoms of cough and/or difficulty breathing, and seasonality was inconsistently associated, dependant on region. CONCLUSION There is a clear evidence gap around the burden of pediatric pneumonia in Nigeria, and challenges with the interpretation of existing household survey data. Improved survey approaches are needed to understand the risks of pediatric pneumonia in Nigeria, alongside the need for investment in reliable routine data systems to provide data on the clinical pneumonia burden in Nigeria.
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Affiliation(s)
- Agnese Iuliano
- Institute for Global Health, University College London, London, UK
| | - Zeus Aranda
- Institute for Global Health, University College London, London, UK
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Imaria C Agwai
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Funmilayo Shittu
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Hamish Graham
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Adegoke G Falade
- Department of Paediatrics, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Carina King
- Institute for Global Health, University College London, London, UK.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Rué L, Bañez-Coronel M, Creus-Muncunill J, Giralt A, Alcalá-Vida R, Mentxaka G, Kagerbauer B, Zomeño-Abellán MT, Aranda Z, Venturi V, Pérez-Navarro E, Estivill X, Martí E. Targeting CAG repeat RNAs reduces Huntington's disease phenotype independently of huntingtin levels. J Clin Invest 2016; 126:4319-4330. [PMID: 27721240 DOI: 10.1172/jci83185] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/08/2016] [Indexed: 12/11/2022] Open
Abstract
Huntington's disease (HD) is a polyglutamine disorder caused by a CAG expansion in the Huntingtin (HTT) gene exon 1. This expansion encodes a mutant protein whose abnormal function is traditionally associated with HD pathogenesis; however, recent evidence has also linked HD pathogenesis to RNA stable hairpins formed by the mutant HTT expansion. Here, we have shown that a locked nucleic acid-modified antisense oligonucleotide complementary to the CAG repeat (LNA-CTG) preferentially binds to mutant HTT without affecting HTT mRNA or protein levels. LNA-CTGs produced rapid and sustained improvement of motor deficits in an R6/2 mouse HD model that was paralleled by persistent binding of LNA-CTG to the expanded HTT exon 1 transgene. Motor improvement was accompanied by a pronounced recovery in the levels of several striatal neuronal markers severely impaired in R6/2 mice. Furthermore, in R6/2 mice, LNA-CTG blocked several pathogenic mechanisms caused by expanded CAG RNA, including small RNA toxicity and decreased Rn45s expression levels. These results suggest that LNA-CTGs promote neuroprotection by blocking the detrimental activity of CAG repeats within HTT mRNA. The present data emphasize the relevance of expanded CAG RNA to HD pathogenesis, indicate that inhibition of HTT expression is not required to reverse motor deficits, and further suggest a therapeutic potential for LNA-CTG in polyglutamine disorders.
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