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Razafinjato B, Rakotonirina L, Cordier LF, Rasoarivao A, Andrianomenjanahary M, Marovavy L, Hanitriniaina F, Andriamiandra IJ, Mayfield A, Palazuelos D, Cowley G, Ramarson A, Ihantamalala F, Rakotonanahary RJL, Miller AC, Garchitorena A, McCarty MG, Bonds MH, Finnegan KE. Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar. PLOS Glob Public Health 2024; 4:e0002888. [PMID: 38470906 DOI: 10.1371/journal.pgph.0002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/17/2024] [Indexed: 03/14/2024]
Abstract
Despite widespread adoption of community health (CH) systems, there are evidence gaps to support global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. The nongovernmental health organization Pivot partnered with the Ministry of Public Health (MoPH) to pilot a new enhanced community health (ECH) model in rural Madagascar, where one CHW provided care at a stationary CH site while additional CHWs provided care via proactive household visits. The program included professionalization of the CHW workforce (i.e., targeted recruitment, extended training, financial compensation) and twice monthly supervision of CHWs. For the first eighteen months of implementation (October 2019-March 2021), we compared utilization and proxy measures of quality of care in the intervention commune (local administrative unit) and five comparison communes with strengthened community health programs under a different model. This allowed for a quasi-experimental study design of the impact of ECH on health outcomes using routinely collected programmatic data. Despite the substantial support provided to other CHWs, the results show statistically significant improvements in nearly every indicator. Sick child visits increased by more than 269.0% in the intervention following ECH implementation. Average per capita monthly under-five visits were 0.25 in the intervention commune and 0.19 in the comparison communes (p<0.01). In the intervention commune, 40.3% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 85.4% of observed visits in the intervention commune (vs 57.7% in the comparison communes, p-value<0.01). This evaluation demonstrates that ECH can improve care access and the quality of service delivery in a rural health district. Further research is needed to assess the generalizability of results and the feasibility of national scale-up as the MoPH continues to define the national community health program.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alishya Mayfield
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel Palazuelos
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | | | | | - Felana Ihantamalala
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rado J L Rakotonanahary
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann C Miller
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andres Garchitorena
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Institut de Recherche pour le Développement, MIVEGEC Laboratory, University of Montpellier, Centre National de la Recherche Scientifique, Antananarivo, Madagascar
| | | | - Matthew H Bonds
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Karen E Finnegan
- Pivot, Ranomafana, Fianarantsoa, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Garchitorena A, Rasoloharimanana LT, Rakotonanahary RJ, Evans MV, Miller AC, Finnegan KE, Cordier LF, Cowley G, Razafinjato B, Randriamanambintsoa M, Andrianambinina S, Popper SJ, Hotahiene R, Bonds MH, Schoenhals M. Morbidity and mortality burden of COVID-19 in rural Madagascar: results from a longitudinal cohort and nested seroprevalence study. Int J Epidemiol 2023; 52:1745-1755. [PMID: 37793001 DOI: 10.1093/ije/dyad135] [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: 03/14/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Three years into the pandemic, there remains significant uncertainty about the true infection and mortality burden of COVID-19 in the World Health Organization Africa region. High quality, population-representative studies in Africa are rare and tend to be conducted in national capitals or large cities, leaving a substantial gap in our understanding of the impact of COVID-19 in rural, low-resource settings. Here, we estimated the spatio-temporal morbidity and mortality burden associated with COVID-19 in a rural health district of Madagascar until the first half of 2021. METHODS We integrated a nested seroprevalence study within a pre-existing longitudinal cohort conducted in a representative sample of 1600 households in Ifanadiana District, Madagascar. Socio-demographic and health information was collected in combination with dried blood spots for about 6500 individuals of all ages, which were analysed to detect IgG and IgM antibodies against four specific proteins of SARS-CoV-2 in a bead-based multiplex immunoassay. We evaluated spatio-temporal patterns in COVID-19 infection history and its associations with several geographic, socio-economic and demographic factors via logistic regressions. RESULTS Eighteen percent of people had been infected by April-June 2021, with seroprevalence increasing with individuals' age. COVID-19 primarily spread along the only paved road and in major towns during the first epidemic wave, subsequently spreading along secondary roads during the second wave to more remote areas. Wealthier individuals and those with occupations such as commerce and formal employment were at higher risk of being infected in the first wave. Adult mortality increased in 2020, particularly for older men for whom it nearly doubled up to nearly 40 deaths per 1000. Less than 10% of mortality in this period would be directly attributed to COVID-19 deaths if known infection fatality ratios are applied to observed seroprevalence in the district. CONCLUSION Our study provides a very granular understanding on COVID-19 transmission and mortality in a rural population of sub-Saharan Africa and suggests that the disease burden in these areas may have been substantially underestimated.
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Affiliation(s)
- Andres Garchitorena
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- NGO Pivot, Ifanadiana, Madagascar
| | | | - Rado Jl Rakotonanahary
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Michelle V Evans
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Karen E Finnegan
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Samuel Andrianambinina
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Stephen J Popper
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Raphaël Hotahiene
- Direction de lutte contre les maladies transmissibles, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Matthew H Bonds
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Evans MV, Ihantamalala FA, Randriamihaja M, Aina AT, Bonds MH, Finnegan KE, Rakotonanahary RJL, Raza-Fanomezanjanahary M, Razafinjato B, Raobela O, Raholiarimanana SH, Randrianavalona TH, Garchitorena A. Applying a zero-corrected, gravity model estimator reduces bias due to heterogeneity in healthcare utilization in community-scale, passive surveillance datasets of endemic diseases. Sci Rep 2023; 13:21288. [PMID: 38042891 PMCID: PMC10693580 DOI: 10.1038/s41598-023-48390-0] [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: 03/13/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023] Open
Abstract
Data on population health are vital to evidence-based decision making but are rarely adequately localized or updated in continuous time. They also suffer from low ascertainment rates, particularly in rural areas where barriers to healthcare can cause infrequent touch points with the health system. Here, we demonstrate a novel statistical method to estimate the incidence of endemic diseases at the community level from passive surveillance data collected at primary health centers. The zero-corrected, gravity-model (ZERO-G) estimator explicitly models sampling intensity as a function of health facility characteristics and statistically accounts for extremely low rates of ascertainment. The result is a standardized, real-time estimate of disease incidence at a spatial resolution nearly ten times finer than typically reported by facility-based passive surveillance systems. We assessed the robustness of this method by applying it to a case study of field-collected malaria incidence rates from a rural health district in southeastern Madagascar. The ZERO-G estimator decreased geographic and financial bias in the dataset by over 90% and doubled the agreement rate between spatial patterns in malaria incidence and incidence estimates derived from prevalence surveys. The ZERO-G estimator is a promising method for adjusting passive surveillance data of common, endemic diseases, increasing the availability of continuously updated, high quality surveillance datasets at the community scale.
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Affiliation(s)
- Michelle V Evans
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France.
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar.
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA.
| | - Felana A Ihantamalala
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Mauricianot Randriamihaja
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
| | | | - Matthew H Bonds
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Karen E Finnegan
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Rado J L Rakotonanahary
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | | | | | - Oméga Raobela
- National Malaria Program, Ministry of Health, Antananarivo, Madagascar
| | | | | | - Andres Garchitorena
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
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Vora NM, Hannah L, Walzer C, Vale MM, Lieberman S, Emerson A, Jennings J, Alders R, Bonds MH, Evans J, Chilukuri B, Cook S, Sizer NC, Epstein JH. Interventions to Reduce Risk for Pathogen Spillover and Early Disease Spread to Prevent Outbreaks, Epidemics, and Pandemics. Emerg Infect Dis 2023; 29:1-9. [PMID: 36823026 PMCID: PMC9973692 DOI: 10.3201/eid2903.221079] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The pathogens that cause most emerging infectious diseases in humans originate in animals, particularly wildlife, and then spill over into humans. The accelerating frequency with which humans and domestic animals encounter wildlife because of activities such as land-use change, animal husbandry, and markets and trade in live wildlife has created growing opportunities for pathogen spillover. The risk of pathogen spillover and early disease spread among domestic animals and humans, however, can be reduced by stopping the clearing and degradation of tropical and subtropical forests, improving health and economic security of communities living in emerging infectious disease hotspots, enhancing biosecurity in animal husbandry, shutting down or strictly regulating wildlife markets and trade, and expanding pathogen surveillance. We summarize expert opinions on how to implement these goals to prevent outbreaks, epidemics, and pandemics.
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Pourtois JD, Tallam K, Jones I, Hyde E, Chamberlin AJ, Evans MV, Ihantamalala FA, Cordier LF, Razafinjato BR, Rakotonanahary RJL, Tsirinomen'ny Aina A, Soloniaina P, Raholiarimanana SH, Razafinjato C, Bonds MH, De Leo GA, Sokolow SH, Garchitorena A. Climatic, land-use and socio-economic factors can predict malaria dynamics at fine spatial scales relevant to local health actors: Evidence from rural Madagascar. PLOS Glob Public Health 2023; 3:e0001607. [PMID: 36963091 PMCID: PMC10021226 DOI: 10.1371/journal.pgph.0001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
While much progress has been achieved over the last decades, malaria surveillance and control remain a challenge in countries with limited health care access and resources. High-resolution predictions of malaria incidence using routine surveillance data could represent a powerful tool to health practitioners by targeting malaria control activities where and when they are most needed. Here, we investigate the predictors of spatio-temporal malaria dynamics in rural Madagascar, estimated from facility-based passive surveillance data. Specifically, this study integrates climate, land-use, and representative household survey data to explain and predict malaria dynamics at a high spatial resolution (i.e., by Fokontany, a cluster of villages) relevant to health care practitioners. Combining generalized linear mixed models (GLMM) and path analyses, we found that socio-economic, land use and climatic variables are all important predictors of monthly malaria incidence at fine spatial scales, via both direct and indirect effects. In addition, out-of-sample predictions from our model were able to identify 58% of the Fokontany in the top quintile for malaria incidence and account for 77% of the variation in the Fokontany incidence rank. These results suggest that it is possible to build a predictive framework using environmental and social predictors that can be complementary to standard surveillance systems and help inform control strategies by field actors at local scales.
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Affiliation(s)
- Julie D Pourtois
- Biology Department, Stanford University, Stanford, CA, United States of America
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, United States of America
| | - Krti Tallam
- Biology Department, Stanford University, Stanford, CA, United States of America
| | - Isabel Jones
- Biology Department, Stanford University, Stanford, CA, United States of America
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, United States of America
| | - Elizabeth Hyde
- School of Medicine, Stanford University, Stanford, CA, United States of America
| | - Andrew J Chamberlin
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, United States of America
| | - Michelle V Evans
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Felana A Ihantamalala
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- NGO Pivot, Ifanadiana, Madagascar
| | | | | | - Rado J L Rakotonanahary
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- NGO Pivot, Ifanadiana, Madagascar
| | | | | | | | - Celestin Razafinjato
- Programme National de Lutte contre le Paludisme, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- NGO Pivot, Ifanadiana, Madagascar
| | - Giulio A De Leo
- Biology Department, Stanford University, Stanford, CA, United States of America
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, United States of America
| | - Susanne H Sokolow
- Woods Institute for the Environment, Stanford University, Stanford, CA, United States of America
- Marine Science Institute and Department of Ecology, Evolution and Marine Biology, University of California, Santa Barbara, CA, United States of America
| | - Andres Garchitorena
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
- NGO Pivot, Ifanadiana, Madagascar
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Sokolow SH, Nova N, Jones IJ, Wood CL, Lafferty KD, Garchitorena A, Hopkins SR, Lund AJ, MacDonald AJ, LeBoa C, Peel AJ, Mordecai EA, Howard ME, Buck JC, Lopez-Carr D, Barry M, Bonds MH, De Leo GA. Ecological and socioeconomic factors associated with the human burden of environmentally mediated pathogens: a global analysis. Lancet Planet Health 2022; 6:e870-e879. [PMID: 36370725 PMCID: PMC9669458 DOI: 10.1016/s2542-5196(22)00248-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 08/22/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Billions of people living in poverty are at risk of environmentally mediated infectious diseases-that is, pathogens with environmental reservoirs that affect disease persistence and control and where environmental control of pathogens can reduce human risk. The complex ecology of these diseases creates a global health problem not easily solved with medical treatment alone. METHODS We quantified the current global disease burden caused by environmentally mediated infectious diseases and used a structural equation model to explore environmental and socioeconomic factors associated with the human burden of environmentally mediated pathogens across all countries. FINDINGS We found that around 80% (455 of 560) of WHO-tracked pathogen species known to infect humans are environmentally mediated, causing about 40% (129 488 of 359 341 disability-adjusted life years) of contemporary infectious disease burden (global loss of 130 million years of healthy life annually). The majority of this environmentally mediated disease burden occurs in tropical countries, and the poorest countries carry the highest burdens across all latitudes. We found weak associations between disease burden and biodiversity or agricultural land use at the global scale. In contrast, the proportion of people with rural poor livelihoods in a country was a strong proximate indicator of environmentally mediated infectious disease burden. Political stability and wealth were associated with improved sanitation, better health care, and lower proportions of rural poverty, indirectly resulting in lower burdens of environmentally mediated infections. Rarely, environmentally mediated pathogens can evolve into global pandemics (eg, HIV, COVID-19) affecting even the wealthiest communities. INTERPRETATION The high and uneven burden of environmentally mediated infections highlights the need for innovative social and ecological interventions to complement biomedical advances in the pursuit of global health and sustainability goals. FUNDING Bill & Melinda Gates Foundation, National Institutes of Health, National Science Foundation, Alfred P. Sloan Foundation, National Institute for Mathematical and Biological Synthesis, Stanford University, and the US Defense Advanced Research Projects Agency.
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Affiliation(s)
- Susanne H Sokolow
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA; Marine Science Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Nicole Nova
- Department of Biology, Stanford University, Stanford, CA, USA; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
| | - Isabel J Jones
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, USA
| | - Chelsea L Wood
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, USA
| | - Kevin D Lafferty
- US Geological Survey, Western Ecological Research Center, c/o Marine Science Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Andres Garchitorena
- MIVEGEC, Université Montpellier, Centre National de la Recherche Scientifique, Institut de Recherche pour le Développement, Montpellier, France; PIVOT, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Andrea J Lund
- Emmett Interdisciplinary Program in Environment and Resources (E-IPER), Stanford University, Stanford, CA, USA
| | - Andrew J MacDonald
- Department of Biology, Stanford University, Stanford, CA, USA; Earth Research Institute, University of California Santa Barbara, Santa Barbara, CA, USA
| | | | - Alison J Peel
- Centre for Planetary Health and Food Security, Griffith University, Nathan, QLD, Australia
| | - Erin A Mordecai
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Meghan E Howard
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Julia C Buck
- Department of Biology and Marine Biology, University of North Carolina Wilmington, Wilmington, NC, USA
| | - David Lopez-Carr
- Department of Geography, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Michele Barry
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA; Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
| | - Matthew H Bonds
- PIVOT, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - Giulio A De Leo
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA; Department of Biology, Stanford University, Stanford, CA, USA; Hopkins Marine Station, Stanford University, Pacific Grove, CA, USA
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7
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Cancedda C, Bonds MH, Nkomazana O, Abimbola S, Binagwaho A. Sustainability in global health: a low ceiling, a star in the sky, or the mountaintop? BMJ Glob Health 2022; 7:bmjgh-2022-011132. [DOI: 10.1136/bmjgh-2022-011132] [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] [Received: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022] Open
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Hopkins SR, Lafferty KD, Wood CL, Olson SH, Buck JC, De Leo GA, Fiorella KJ, Fornberg JL, Garchitorena A, Jones IJ, Kuris AM, Kwong LH, LeBoa C, Leon AE, Lund AJ, MacDonald AJ, Metz DCG, Nova N, Peel AJ, Remais JV, Stewart Merrill TE, Wilson M, Bonds MH, Dobson AP, Lopez Carr D, Howard ME, Mandle L, Sokolow SH. Evidence gaps and diversity among potential win-win solutions for conservation and human infectious disease control. Lancet Planet Health 2022; 6:e694-e705. [PMID: 35932789 PMCID: PMC9364143 DOI: 10.1016/s2542-5196(22)00148-6] [Citation(s) in RCA: 2] [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: 04/20/2021] [Revised: 05/21/2022] [Accepted: 06/14/2022] [Indexed: 06/08/2023]
Abstract
As sustainable development practitioners have worked to "ensure healthy lives and promote well-being for all" and "conserve life on land and below water", what progress has been made with win-win interventions that reduce human infectious disease burdens while advancing conservation goals? Using a systematic literature review, we identified 46 proposed solutions, which we then investigated individually using targeted literature reviews. The proposed solutions addressed diverse conservation threats and human infectious diseases, and thus, the proposed interventions varied in scale, costs, and impacts. Some potential solutions had medium-quality to high-quality evidence for previous success in achieving proposed impacts in one or both sectors. However, there were notable evidence gaps within and among solutions, highlighting opportunities for further research and adaptive implementation. Stakeholders seeking win-win interventions can explore this Review and an online database to find and tailor a relevant solution or brainstorm new solutions.
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Affiliation(s)
- Skylar R Hopkins
- Department of Applied Ecology, North Carolina State University, Raleigh, NC, USA; National Center for Ecological Analysis and Synthesis, Santa Barbara, CA, USA.
| | - Kevin D Lafferty
- Western Ecological Research Center, US Geological Survey at Marine Science Institute, University of California, Santa Barbara, CA, USA
| | - Chelsea L Wood
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA, USA
| | - Sarah H Olson
- Wildlife Conservation Society, Health Program, Bronx, NY, USA
| | - Julia C Buck
- Department of Biology and Marine Biology, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Giulio A De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, USA
| | - Kathryn J Fiorella
- Department of Population Medicine and Diagnostic Sciences and Master of Public Health Program, Cornell University, Ithaca, NY, USA
| | - Johanna L Fornberg
- Department of Ecology, Evolution, and Marine Biology, University of California, Santa Barbara, CA, USA
| | - Andres Garchitorena
- MIVEGEC, Université Montpellier, Centre National de la Recherche Scientifique, Institut de Recherche pour le Développement, Montpellier, France; NGO PIVOT, Ranomafana, Madagascar
| | - Isabel J Jones
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, USA
| | - Armand M Kuris
- Department of Ecology, Evolution, and Marine Biology, University of California, Santa Barbara, CA, USA
| | - Laura H Kwong
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | | | - Ariel E Leon
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, USA; US Geological Survey, National Wildlife Health Center, Madison, WI, USA
| | - Andrea J Lund
- Department of Environmental and Occupational Health, University of Colorado School of Public Health, Aurora, CO, USA
| | - Andrew J MacDonald
- Bren School of Environmental Science and Management, University of California, Santa Barbara, CA, USA
| | - Daniel C G Metz
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Nicole Nova
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Alison J Peel
- Centre for Planetary Health and Food Security, Griffith University, Nathan, QLD, Australia
| | - Justin V Remais
- Division of Environmental Health Sciences, University of California, Berkeley, CA, USA
| | | | - Maya Wilson
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrew P Dobson
- Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - David Lopez Carr
- Department of Geography, University of California, Santa Barbara, CA, USA
| | - Meghan E Howard
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Lisa Mandle
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | - Susanne H Sokolow
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
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9
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Rajaonarifara E, Bonds MH, Miller AC, Ihantamalala FA, Cordier L, Razafinjato B, Rafenoarimalala FH, Finnegan KE, Rakotonanahary RJL, Cowley G, Ratsimbazafy B, Razafimamonjy F, Randriamanambintsoa M, Raza-Fanomezanjanahary EM, Randrianambinina A, Metcalf CJ, Roche B, Garchitorena A. Impact of health system strengthening on delivery strategies to improve child immunisation coverage and inequalities in rural Madagascar. BMJ Glob Health 2022; 7:bmjgh-2021-006824. [PMID: 35012969 PMCID: PMC8753401 DOI: 10.1136/bmjgh-2021-006824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/06/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background To reach global immunisation goals, national programmes need to balance routine immunisation at health facilities with vaccination campaigns and other outreach activities (eg, vaccination weeks), which boost coverage at particular times and help reduce geographical inequalities. However, where routine immunisation is weak, an over-reliance on vaccination campaigns may lead to heterogeneous coverage. Here, we assessed the impact of a health system strengthening (HSS) intervention on the relative contribution of routine immunisation and outreach activities to reach immunisation goals in rural Madagascar. Methods We obtained data from health centres in Ifanadiana district on the monthly number of recommended vaccines (BCG, measles, diphtheria, tetanus and pertussis (DTP) and polio) delivered to children, during 2014–2018. We also analysed data from a district-representative cohort carried out every 2 years in over 1500 households in 2014–2018. We compared changes inside and outside the HSS catchment in the delivery of recommended vaccines, population-level vaccination coverage, geographical and economic inequalities in coverage, and timeliness of vaccination. The impact of HSS was quantified via mixed-effects logistic regressions. Results The HSS intervention was associated with a significant increase in immunisation rates (OR between 1.22 for measles and 1.49 for DTP), which diminished over time. Outreach activities were associated with a doubling in immunisation rates, but their effect was smaller in the HSS catchment. Analysis of cohort data revealed that HSS was associated with higher vaccination coverage (OR between 1.18 per year of HSS for measles and 1.43 for BCG), a reduction in economic inequality, and a higher proportion of timely vaccinations. Yet, the lower contribution of outreach activities in the HSS catchment was associated with persistent inequalities in geographical coverage, which prevented achieving international coverage targets. Conclusion Investment in stronger primary care systems can improve vaccination coverage, reduce inequalities and improve the timeliness of vaccination via increases in routine immunisations.
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Affiliation(s)
- Elinambinina Rajaonarifara
- Sciences & Ingénierie, Sorbonne Universite, Paris, France .,UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,NGO PIVOT, Ranomafana, Madagascar
| | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Karen E Finnegan
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - C Jessica Metcalf
- Dept of Ecology and Evol. Biology, Princeton University, Princeton, New Jersey, USA
| | - Benjamin Roche
- UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,Universidad Nacional Autónoma de México, Coyoacan, Distrito Federal, Mexico
| | - Andres Garchitorena
- UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,NGO PIVOT, Ranomafana, Madagascar
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10
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Evans MV, Andréambeloson T, Randriamihaja M, Ihantamalala F, Cordier L, Cowley G, Finnegan K, Hanitriniaina F, Miller AC, Ralantomalala LM, Randriamahasoa A, Razafinjato B, Razanahanitriniaina E, Rakotonanahary RJL, Andriamiandra IJ, Bonds MH, Garchitorena A. Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar. PLOS Glob Public Health 2022; 2:e0001028. [PMID: 36962826 PMCID: PMC10022327 DOI: 10.1371/journal.pgph.0001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/26/2022] [Indexed: 12/28/2022]
Abstract
Geographic distance is a critical barrier to healthcare access, particularly for rural communities with poor transportation infrastructure who rely on non-motorized transportation. There is broad consensus on the importance of community health workers (CHWs) to reduce the effects of geographic isolation on healthcare access. Due to a lack of fine-scale spatial data and individual patient records, little is known about the precise effects of CHWs on removing geographic barriers at this level of the healthcare system. Relying on a high-quality, crowd-sourced dataset that includes all paths and buildings in the area, we explored the impact of geographic distance from CHWs on the use of CHW services for children under 5 years in the rural district of Ifanadiana, southeastern Madagascar from 2018-2021. We then used this analysis to determine key features of an optimal geographic design of the CHW system, specifically optimizing a single CHW location or installing additional CHW sites. We found that consultation rates by CHWs decreased with increasing distance patients travel to the CHW by approximately 28.1% per km. The optimization exercise revealed that the majority of CHW sites (50/80) were already in an optimal location or shared an optimal location with a primary health clinic. Relocating the remaining CHW sites based on a geographic optimum was predicted to increase consultation rates by only 7.4%. On the other hand, adding a second CHW site was predicted to increase consultation rates by 31.5%, with a larger effect in more geographically dispersed catchments. Geographic distance remains a barrier at the level of the CHW, but optimizing CHW site location based on geography alone will not result in large gains in consultation rates. Rather, alternative strategies, such as the creation of additional CHW sites or the implementation of proactive care, should be considered.
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Affiliation(s)
| | | | | | - Felana Ihantamalala
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | | | | | | | | | - Ann C Miller
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | | | | | | | | | | | | | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, United Sates of America
| | - Andres Garchitorena
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
- NGO PIVOT, Ranomafana, Ifanadiana, Madagascar
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11
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Ihantamalala FA, Bonds MH, Randriamihaja M, Rakotonirina L, Herbreteau V, Révillion C, Rakotoarimanana S, Cowley G, Andriatiana TA, Mayfield A, Rich ML, Rakotonanahary RJL, Finnegan KE, Ramarson A, Razafinjato B, Ramiandrisoa B, Randrianambinina A, Cordier LF, Garchitorena A. Geographic barriers to establishing a successful hospital referral system in rural Madagascar. BMJ Glob Health 2021; 6:bmjgh-2021-007145. [PMID: 34880062 PMCID: PMC8655550 DOI: 10.1136/bmjgh-2021-007145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/09/2021] [Accepted: 11/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background The provision of emergency and hospital care has become an integral part of the global vision for universal health coverage. To strengthen secondary care systems, we need to accurately understand the time necessary for populations to reach a hospital. The goal of this study was to develop methods that accurately estimate referral and prehospital time for rural districts in low and middle-income countries. We used these estimates to assess how local geography can limit the impact of a strengthened referral programme in a rural district of Madagascar. Methods We developed a database containing: travel speed by foot and motorised vehicles in Ifanadiana district; a full mapping of all roads, footpaths and households; and remotely sensed data on terrain, land cover and climatic characteristics. We used this information to calibrate estimates of referral and prehospital time based on the shortest route algorithms and statistical models of local travel speed. We predict the impact on referral numbers of strategies aimed at reducing referral time for underserved populations via generalised linear mixed models. Results About 10% of the population lived less than 2 hours from the hospital, and more than half lived over 4 hours away, with variable access depending on climatic conditions. Only the four health centres located near the paved road had referral times to the hospital within 1 hour. Referral time remained the main barrier limiting the number of referrals despite health system strengthening efforts. The addition of two new referral centres is estimated to triple the population living within 2 hours from a centre with better emergency care capacity and nearly double the number of expected referrals. Conclusion This study demonstrates how adapting geographic accessibility modelling methods to local scales can occur through improving the precision of travel time estimates and pairing them with data on health facility use.
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Affiliation(s)
- Felana Angella Ihantamalala
- Research, NGO PIVOT, Ifanadiana, Fianarantsoa, Madagascar .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,NGO PIVOT, Ranomafana, Madagascar
| | | | | | - Vincent Herbreteau
- Espace-Dev, IRD, Université des Antilles, Université de Guyane, Université de Montpellier, Université de La Réunion, Phnom Penh, Cambodia
| | - Christophe Révillion
- Espace-Dev, IRD, Université des Antilles, Université de Guyane, Université de Montpellier, Université de La Réunion, Saint-Pierre, France
| | | | | | | | - Alishya Mayfield
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,NGO PIVOT, Ranomafana, Madagascar
| | - Michael L Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,NGO PIVOT, Ranomafana, Madagascar.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - Andres Garchitorena
- NGO PIVOT, Ranomafana, Madagascar.,MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
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12
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Garchitorena A, Ihantamalala FA, Révillion C, Cordier LF, Randriamihaja M, Razafinjato B, Rafenoarivamalala FH, Finnegan KE, Andrianirinarison JC, Rakotonirina J, Herbreteau V, Bonds MH. Geographic barriers to achieving universal health coverage: evidence from rural Madagascar. Health Policy Plan 2021; 36:1659-1670. [PMID: 34331066 PMCID: PMC8597972 DOI: 10.1093/heapol/czab087] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 11/12/2022] Open
Abstract
Poor geographic access can persist even when affordable and well-functioning health systems are in place, limiting efforts for universal health coverage (UHC). It is unclear how to balance support for health facilities and community health workers in UHC national strategies. The goal of this study was to evaluate how a health system strengthening (HSS) intervention aimed towards UHC affected the geographic access to primary care in a rural district of Madagascar. For this, we collected the fokontany of residence (lowest administrative unit) from nearly 300 000 outpatient consultations occurring in facilities of Ifanadiana district in 2014-2017 and in the subset of community sites supported by the HSS intervention. Distance from patients to facilities was accurately estimated following a full mapping of the district's footpaths and residential areas. We modelled per capita utilization for each fokontany through interrupted time-series analyses with control groups, accounting for non-linear relationships with distance and travel time among other factors, and we predicted facility utilization across the district under a scenario with and without HSS. Finally, we compared geographic trends in primary care when combining utilization at health facilities and community sites. We find that facility-based interventions similar to those in UHC strategies achieved high utilization rates of 1-3 consultations per person year only among populations living in close proximity to facilities. We predict that scaling only facility-based HSS programmes would result in large gaps in access, with over 75% of the population unable to reach one consultation per person year. Community health delivery, available only for children under 5 years, provided major improvements in service utilization regardless of their distance from facilities, contributing to 90% of primary care consultations in remote populations. Our results reveal the geographic limits of current UHC strategies and highlight the need to invest on professionalized community health programmes with larger scopes of service.
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Affiliation(s)
- Andres Garchitorena
- MIVEGEC, University Montpellier, CNRS, IRD, 911 Avenue Agropolis, 34394 Montpellier, Montpellier, France
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
| | | | - Christophe Révillion
- Université de La Réunion, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), 40 Av De Soweto, 97410 Saint-Pierre, Réunion, France
| | | | - Mauricianot Randriamihaja
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- School of Management and Technological innovation, University of Fianarantsoa, BP 1135 Andrainjato, 301 Fianarantsoa, Madagascar
| | | | | | - Karen E Finnegan
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA
| | - Jean Claude Andrianirinarison
- Ministry of Public Health, Ambohidahy, 101 Antananarivo, Madagascar
- National Institut of Public Health, Befelatanana, 101 Antananarivo, Madagascar
| | - Julio Rakotonirina
- Ministry of Public Health, Ambohidahy, 101 Antananarivo, Madagascar
- Faculty of Medicine, BP. 375, 101 Antananarivo, Madagascar
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), B.P. 86, Phnom Penh, Cambodia
| | - Matthew H Bonds
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA
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13
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Ngonghala CN, Knitter JR, Marinacci L, Bonds MH, Gumel AB. Assessing the impact of widespread respirator use in curtailing COVID-19 transmission in the USA. R Soc Open Sci 2021; 8:210699. [PMID: 34527275 PMCID: PMC8424336 DOI: 10.1098/rsos.210699] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/25/2021] [Indexed: 05/14/2023]
Abstract
Dynamic models are used to assess the impact of three types of face masks (cloth masks, surgical/procedure masks and respirators) in controlling the COVID-19 pandemic in the USA. We showed that the pandemic would have failed to establish in the USA if a nationwide mask mandate, based on using respirators with moderately high compliance, had been implemented during the first two months of the pandemic. The other mask types would fail to prevent the pandemic from becoming established. When mask usage compliance is low to moderate, respirators are far more effective in reducing disease burden. Using data from the third wave, we showed that the epidemic could be eliminated in the USA if at least 40% of the population consistently wore respirators in public. Surgical masks can also lead to elimination, but requires compliance of at least 55%. Daily COVID-19 mortality could be eliminated in the USA by June or July 2021 if 95% of the population opted for either respirators or surgical masks from the beginning of the third wave. We showed that the prospect of effective control or elimination of the pandemic using mask-based strategy is greatly enhanced if combined with other non-pharmaceutical interventions (NPIs) that significantly reduce the baseline community transmission. By slightly modifying the model to include the effect of a vaccine against COVID-19 and waning vaccine-derived and natural immunity, this study shows that the waning of such immunity could trigger multiple new waves of the pandemic in the USA. The number, severity and duration of the projected waves depend on the quality of mask type used and the level of increase in the baseline levels of other NPIs used in the community during the onset of the third wave of the pandemic in the USA. Specifically, no severe fourth or subsequent wave of the pandemic will be recorded in the USA if surgical masks or respirators are used, particularly if the mask use strategy is combined with an increase in the baseline levels of other NPIs. This study further emphasizes the role of human behaviour towards masking on COVID-19 burden, and highlights the urgent need to maintain a healthy stockpile of highly effective respiratory protection, particularly respirators, to be made available to the general public in times of future outbreaks or pandemics of respiratory diseases that inflict severe public health and socio-economic burden on the population.
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Affiliation(s)
- Calistus N. Ngonghala
- Department of Mathematics, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - James R. Knitter
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Lucas Marinacci
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Abba B. Gumel
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ, USA
- Department of Mathematics and Applied Mathematics, University of Pretoria, Pretoria, South Africa
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14
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Rakotonanahary RJL, Andriambolamanana H, Razafinjato B, Raza-Fanomezanjanahary EM, Ramanandraitsiory V, Ralaivavikoa F, Tsirinomen'ny Aina A, Rahajatiana L, Rakotonirina L, Haruna J, Cordier LF, Murray MB, Cowley G, Jordan D, Krasnow MA, Wright PC, Gillespie TR, Docherty M, Loyd T, Evans MV, Drake JM, Ngonghala CN, Rich ML, Popper SJ, Miller AC, Ihantamalala FA, Randrianambinina A, Ramiandrisoa B, Rakotozafy E, Rasolofomanana A, Rakotozafy G, Andriamahatana Vololoniaina MC, Andriamihaja B, Garchitorena A, Rakotonirina J, Mayfield A, Finnegan KE, Bonds MH. Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Rural Madagascar. Front Public Health 2021; 9:654299. [PMID: 34368043 PMCID: PMC8333873 DOI: 10.3389/fpubh.2021.654299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/15/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district-community, primary care centers, hospital-including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Demetrice Jordan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Mark A. Krasnow
- Centre Valbio, Ranomafana, Madagascar
- Department of Biochemistry, Stanford University, Stanford, CA, United States
| | - Patricia C. Wright
- Centre Valbio, Ranomafana, Madagascar
- Institute for the Conservation of Tropical Environments, Stony Brook University, Stony Brook, NY, United States
- Department of Anthropology, Stony Brook University, Stony Brook, NY, United States
| | - Thomas R. Gillespie
- Centre Valbio, Ranomafana, Madagascar
- Department of Environmental Sciences and Program in Population Biology, Ecology, and Evolutionary Biology, Emory University, Atlanta, GA, United States
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | | | - Michelle V. Evans
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, United States
| | - John M. Drake
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, United States
| | - Calistus N. Ngonghala
- Department of Mathematics, University of Florida, Gainesville, FL, United States
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Center for African Studies, University of Florida, Gainesville, FL, United States
| | - Michael L. Rich
- PIVOT NGO, Ranomafana, Madagascar
- Brigham and Women's Hospital, Boston, MA, United States
- Partners in Health, Boston, MA, United States
| | - Stephen J. Popper
- PIVOT NGO, Ranomafana, Madagascar
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Ann C. Miller
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | | | | | | | | | | | | | | | - Andres Garchitorena
- PIVOT NGO, Ranomafana, Madagascar
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Julio Rakotonirina
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | - Alishya Mayfield
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Karen E. Finnegan
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Matthew H. Bonds
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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15
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Garchitorena A, Miller AC, Cordier LF, Randriamanambintsoa M, Razanadrakato HTR, Randriamihaja M, Razafinjato B, Finnegan KE, Haruna J, Rakotonirina L, Rakotozafy G, Raharimamonjy L, Atwood S, Murray MB, Rich M, Loyd T, Solofomalala GD, Bonds MH. District-level health system strengthening for universal health coverage: evidence from a longitudinal cohort study in rural Madagascar, 2014-2018. BMJ Glob Health 2021; 5:bmjgh-2020-003647. [PMID: 33272943 PMCID: PMC7716667 DOI: 10.1136/bmjgh-2020-003647] [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: 08/08/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Despite renewed commitment to universal health coverage and health system strengthening (HSS) to improve access to primary care, there is insufficient evidence to guide their design and implementation. To address this, we conducted an impact evaluation of an ongoing HSS initiative in rural Madagascar, combining data from a longitudinal cohort and primary health centres. Methods We carried out a district representative household survey at the start of the HSS intervention in 2014 in over 1500 households in Ifanadiana district, and conducted follow-up surveys at 2 and 4 years. At each time point, we estimated maternal, newborn and child health coverage; economic and geographical inequalities in coverage; and child mortality rates; both in the HSS intervention and control catchments. We used logistic regression models to evaluate changes associated with exposure to the HSS intervention. We also estimated changes in health centre per capita utilisation during 2013 to 2018. Results Child mortality rates decreased faster in the HSS than in the control catchment. We observed significant improvements in care seeking for children under 5 years of age (OR 1.23; 95% CI 1.05 to 1.44) and individuals of all ages (OR 1.37, 95% CI 1.19 to 1.58), but no significant differences in maternal care coverage. Economic inequalities in most coverage indicators were reduced, while geographical inequalities worsened in nearly half of the indicators. Conclusion The results demonstrate improvements in care seeking and economic inequalities linked to the early stages of a HSS intervention in rural Madagascar. Additional improvements in this context of persistent geographical inequalities will require a stronger focus on community health.
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Affiliation(s)
- Andres Garchitorena
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France .,PIVOT, Ifanadiana, Madagascar
| | - Ann C Miller
- PIVOT, Ifanadiana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Hery-Tiana R Razanadrakato
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | - Karen E Finnegan
- PIVOT, Ifanadiana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Matthew H Bonds
- PIVOT, Ifanadiana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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16
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Ngonghala CN, Ryan SJ, Tesla B, Demakovsky LR, Mordecai EA, Murdock CC, Bonds MH. Effects of changes in temperature on Zika dynamics and control. J R Soc Interface 2021; 18:20210165. [PMID: 33947225 PMCID: PMC8097513 DOI: 10.1098/rsif.2021.0165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
When a rare pathogen emerges to cause a pandemic, it is critical to understand its dynamics and the impact of mitigation measures. We use experimental data to parametrize a temperature-dependent model of Zika virus (ZIKV) transmission dynamics and analyse the effects of temperature variability and control-related parameters on the basic reproduction number (R0) and the final epidemic size of ZIKV. Sensitivity analyses show that these two metrics are largely driven by different parameters, with the exception of temperature, which is the dominant driver of epidemic dynamics in the models. Our R0 estimate has a single optimum temperature (≈30°C), comparable to other published results (≈29°C). However, the final epidemic size is maximized across a wider temperature range, from 24 to 36°C. The models indicate that ZIKV is highly sensitive to seasonal temperature variation. For example, although the model predicts that ZIKV transmission cannot occur at a constant temperature below 23°C (≈ average annual temperature of Rio de Janeiro, Brazil), the model predicts substantial epidemics for areas with a mean temperature of 20°C if there is seasonal variation of 10°C (≈ average annual temperature of Tampa, Florida). This suggests that the geographical range of ZIKV is wider than indicated from static R0 models, underscoring the importance of climate dynamics and variation in the context of broader climate change on emerging infectious diseases.
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Affiliation(s)
- Calistus N Ngonghala
- Department of Mathematics, University of Florida, Gainesville, FL 32611, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32608, USA
| | - Sadie J Ryan
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32608, USA
- Quantitative Disease Ecology and Conservation Laboratory, Department of Geography, University of Florida, Gainesville, FL 32611, USA
| | - Blanka Tesla
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA 30602, USA
| | - Leah R Demakovsky
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
| | - Erin A Mordecai
- Biology Department, Stanford University, Stanford, CA 94305, USA
| | - Courtney C Murdock
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
- Odum School of Ecology, University of Georgia, Athens, GA 30602, USA
- Center of Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
- River Basin Center, University of Georgia, Athens, GA 30602, USA
- Agriculture and Life Sciences, Cornell University, Ithaca, NY 14850, USA
- Northeast Regional Center of Excellence for Vector-borne Disease Research and the Cornell Institute for Host-Microbe Interactions and Disease, Cornell University, Ithaca, NY 14850, USA
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
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17
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Evans MV, Bonds MH, Cordier LF, Drake JM, Ihantamalala F, Haruna J, Miller AC, Murdock CC, Randriamanambtsoa M, Raza-Fanomezanjanahary EM, Razafinjato BR, Garchitorena AC. Socio-demographic, not environmental, risk factors explain fine-scale spatial patterns of diarrhoeal disease in Ifanadiana, rural Madagascar. Proc Biol Sci 2021; 288:20202501. [PMID: 33653145 PMCID: PMC7934917 DOI: 10.1098/rspb.2020.2501] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Precision health mapping is a technique that uses spatial relationships between socio-ecological variables and disease to map the spatial distribution of disease, particularly for diseases with strong environmental signatures, such as diarrhoeal disease (DD). While some studies use GPS-tagged location data, other precision health mapping efforts rely heavily on data collected at coarse-spatial scales and may not produce operationally relevant predictions at fine enough spatio-temporal scales to inform local health programmes. We use two fine-scale health datasets collected in a rural district of Madagascar to identify socio-ecological covariates associated with childhood DD. We constructed generalized linear mixed models including socio-demographic, climatic and landcover variables and estimated variable importance via multi-model inference. We find that socio-demographic variables, and not environmental variables, are strong predictors of the spatial distribution of disease risk at both individual and commune-level (cluster of villages) spatial scales. Climatic variables predicted strong seasonality in DD, with the highest incidence in colder, drier months, but did not explain spatial patterns. Interestingly, the occurrence of a national holiday was highly predictive of increased DD incidence, highlighting the need for including cultural factors in modelling efforts. Our findings suggest that precision health mapping efforts that do not include socio-demographic covariates may have reduced explanatory power at the local scale. More research is needed to better define the set of conditions under which the application of precision health mapping can be operationally useful to local public health professionals.
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Affiliation(s)
- Michelle V Evans
- Odum School of Ecology, University of Georgia, Athens, GA, USA.,Center for Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA.,PIVOT, Ranomafana, Madagascar.,PIVOT, Boston, MA, USA
| | | | - John M Drake
- Odum School of Ecology, University of Georgia, Athens, GA, USA.,Center for Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Felana Ihantamalala
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA.,PIVOT, Ranomafana, Madagascar.,PIVOT, Boston, MA, USA
| | - Justin Haruna
- PIVOT, Ranomafana, Madagascar.,PIVOT, Boston, MA, USA
| | - Ann C Miller
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Courtney C Murdock
- Odum School of Ecology, University of Georgia, Athens, GA, USA.,Center for Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA.,Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.,Department of Entomology, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | | | | | | | - Andres C Garchitorena
- PIVOT, Ranomafana, Madagascar.,PIVOT, Boston, MA, USA.,MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
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18
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Affiliation(s)
- Ann C. Miller
- Ann C. Miller and Matthew H. Bonds are with the Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, and the health care nongovernmental organization PIVOT, Ranomafana, Madagascar
| | - Matthew H. Bonds
- Ann C. Miller and Matthew H. Bonds are with the Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, and the health care nongovernmental organization PIVOT, Ranomafana, Madagascar
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19
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Hyde E, Bonds MH, Ihantamalala FA, Miller AC, Cordier LF, Razafinjato B, Andriambolamanana H, Randriamanambintsoa M, Barry M, Andrianirinarison JC, Andriamananjara MN, Garchitorena A. Estimating the local spatio-temporal distribution of malaria from routine health information systems in areas of low health care access and reporting. Int J Health Geogr 2021; 20:8. [PMID: 33579294 PMCID: PMC7879399 DOI: 10.1186/s12942-021-00262-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to develop a novel method to obtain accurate estimates of disease spatio-temporal incidence at very local scales from routine passive surveillance, less biased by populations' financial and geographic access to care. METHODS We use a geographically explicit dataset with residences of the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria. RESULTS Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations' financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. By gathering patient-level data and removing systematic biases in the dataset, the spatial resolution of passive malaria surveillance was improved over ten-fold. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years. CONCLUSIONS Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.
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Affiliation(s)
- Elizabeth Hyde
- Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- NGO PIVOT, Ranomafana, Madagascar
| | - Felana A Ihantamalala
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- NGO PIVOT, Ranomafana, Madagascar
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | | | | | - Marius Randriamanambintsoa
- Direction de La Démographie et des Statistiques Sociales, Institut National de La Statistique, Antananarivo, Madagascar
| | - Michele Barry
- Stanford University School of Medicine, Stanford, CA, USA
- Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
| | | | | | - Andres Garchitorena
- NGO PIVOT, Ranomafana, Madagascar.
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France.
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20
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Arthur RF, Jones JH, Bonds MH, Ram Y, Feldman MW. Adaptive social contact rates induce complex dynamics during epidemics. PLoS Comput Biol 2021; 17:e1008639. [PMID: 33566839 PMCID: PMC7875423 DOI: 10.1371/journal.pcbi.1008639] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 07/10/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
Epidemics may pose a significant dilemma for governments and individuals. The personal or public health consequences of inaction may be catastrophic; but the economic consequences of drastic response may likewise be catastrophic. In the face of these trade-offs, governments and individuals must therefore strike a balance between the economic and personal health costs of reducing social contacts and the public health costs of neglecting to do so. As risk of infection increases, potentially infectious contact between people is deliberately reduced either individually or by decree. This must be balanced against the social and economic costs of having fewer people in contact, and therefore active in the labor force or enrolled in school. Although the importance of adaptive social contact on epidemic outcomes has become increasingly recognized, the most important properties of coupled human-natural epidemic systems are still not well understood. We develop a theoretical model for adaptive, optimal control of the effective social contact rate using traditional epidemic modeling tools and a utility function with delayed information. This utility function trades off the population-wide contact rate with the expected cost and risk of increasing infections. Our analytical and computational analysis of this simple discrete-time deterministic strategic model reveals the existence of an endemic equilibrium, oscillatory dynamics around this equilibrium under some parametric conditions, and complex dynamic regimes that shift under small parameter perturbations. These results support the supposition that infectious disease dynamics under adaptive behavior change may have an indifference point, may produce oscillatory dynamics without other forcing, and constitute complex adaptive systems with associated dynamics. Implications for any epidemic in which adaptive behavior influences infectious disease dynamics include an expectation of fluctuations, for a considerable time, around a quasi-equilibrium that balances public health and economic priorities, that shows multiple peaks and surges in some scenarios, and that implies a high degree of uncertainty in mathematical projections.
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Affiliation(s)
- Ronan F. Arthur
- School of Medicine, Stanford University, Stanford, California, United States of America
| | - James H. Jones
- Department of Earth Systems Science, Stanford University, Stanford, California, United States of America
| | - Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Yoav Ram
- School of Computer Science, Interdisciplinary Center Herzliya, Herzliya, Israel
- School of Zoology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
| | - Marcus W. Feldman
- Department of Biology, Stanford University, Stanford, California, United States of America
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21
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Ryan SJ, Carlson CJ, Tesla B, Bonds MH, Ngonghala CN, Mordecai EA, Johnson LR, Murdock CC. Warming temperatures could expose more than 1.3 billion new people to Zika virus risk by 2050. Glob Chang Biol 2021; 27:84-93. [PMID: 33037740 PMCID: PMC7756632 DOI: 10.1111/gcb.15384] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/14/2020] [Indexed: 06/04/2023]
Abstract
In the aftermath of the 2015 pandemic of Zika virus (ZIKV), concerns over links between climate change and emerging arboviruses have become more pressing. Given the potential that much of the world might remain at risk from the virus, we used a previously established temperature-dependent transmission model for ZIKV to project climate change impacts on transmission suitability risk by mid-century (a generation into the future). Based on these model predictions, in the worst-case scenario, over 1.3 billion new people could face suitable transmission temperatures for ZIKV by 2050. The next generation will face substantially increased ZIKV transmission temperature suitability in North America and Europe, where naïve populations might be particularly vulnerable. Mitigating climate change even to moderate emissions scenarios could significantly reduce global expansion of climates suitable for ZIKV transmission, potentially protecting around 200 million people. Given these suitability risk projections, we suggest an increased priority on research establishing the immune history of vulnerable populations, modeling when and where the next ZIKV outbreak might occur, evaluating the efficacy of conventional and novel intervention measures, and increasing surveillance efforts to prevent further expansion of ZIKV.
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Affiliation(s)
- Sadie J. Ryan
- Department of GeographyUniversity of FloridaGainesvilleFLUSA
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFLUSA
- School of Life SciencesUniversity of KwaZulu‐NatalDurbanSouth Africa
| | | | - Blanka Tesla
- Department of Infectious DiseasesCollege of Veterinary MedicineUniversity of GeorgiaAthensGAUSA
- Center for Tropical and Emerging Global DiseasesUniversity of GeorgiaAthensGAUSA
| | - Matthew H. Bonds
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA
| | - Calistus N. Ngonghala
- Emerging Pathogens InstituteUniversity of FloridaGainesvilleFLUSA
- Department of MathematicsUniversity of FloridaGainesvilleFLUSA
| | | | - Leah R. Johnson
- Department of StatisticsVirginia Polytechnic Institute and State UniversityBlacksburgVAUSA
- Computational Modeling and Data AnalyticsVirginia Polytechnic Institute and State UniversityBlacksburgVAUSA
| | - Courtney C. Murdock
- Department of Infectious DiseasesCollege of Veterinary MedicineUniversity of GeorgiaAthensGAUSA
- Center for Tropical and Emerging Global DiseasesUniversity of GeorgiaAthensGAUSA
- Odum School of EcologyUniversity of GeorgiaAthensGAUSA
- Center for the Ecology of Infectious DiseasesUniversity of GeorgiaAthensGAUSA
- Center for Vaccines and ImmunologyCollege of Veterinary MedicineUniversity of GeorgiaAthensGAUSA
- Riverbasin CenterUniversity of GeorgiaAthensGAUSA
- Department of EntomologyCollege of Agriculture and Life SciencesCornell UniversityIthacaNYUSA
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22
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Evans MV, Garchitorena A, Rakotonanahary RJL, Drake JM, Andriamihaja B, Rajaonarifara E, Ngonghala CN, Roche B, Bonds MH, Rakotonirina J. Reconciling model predictions with low reported cases of COVID-19 in Sub-Saharan Africa: insights from Madagascar. Glob Health Action 2020; 13:1816044. [PMID: 33012269 PMCID: PMC7580764 DOI: 10.1080/16549716.2020.1816044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/17/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 has wreaked havoc globally with particular concerns for sub-Saharan Africa (SSA), where models suggest that the majority of the population will become infected. Conventional wisdom suggests that the continent will bear a higher burden of COVID-19 for the same reasons it suffers from other infectious diseases: ecology, socio-economic conditions, lack of water and sanitation infrastructure, and weak health systems. However, so far SSA has reported lower incidence and fatalities compared to the predictions of standard models and the experience of other regions of the world. There are three leading explanations, each with different implications for the final epidemic burden: (1) low case detection, (2) differences in epidemiology (e.g. low R 0 ), and (3) policy interventions. The low number of cases have led some SSA governments to relaxing these policy interventions. Will this result in a resurgence of cases? To understand how to interpret the lower-than-expected COVID-19 case data in Madagascar, we use a simple age-structured model to explore each of these explanations and predict the epidemic impact associated with them. We show that the incidence of COVID-19 cases as of July 2020 can be explained by any combination of the late introduction of first imported cases, early implementation of non-pharmaceutical interventions (NPIs), and low case detection rates. We then re-evaluate these findings in the context of the COVID-19 epidemic in Madagascar through August 2020. This analysis reinforces that Madagascar, along with other countries in SSA, remains at risk of a growing health crisis. If NPIs remain enforced, up to 50,000 lives may be saved. Even with NPIs, without vaccines and new therapies, COVID-19 could infect up to 30% of the population, making it the largest public health threat in Madagascar for the coming year, hence the importance of clinical trials and continually improving access to healthcare.
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Affiliation(s)
- Michelle V. Evans
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Andres Garchitorena
- MIVEGEC, Ecole Pierre Louis de Santé Publique, Université de Montpellier, CNRS, IRD, Montpellier, France
- PIVOT, Ranomafana, Madagascar
| | | | - John M. Drake
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Benjamin Andriamihaja
- PIVOT, Ranomafana, Madagascar
- Madagascar Institut pour la Conservation des Ecosystèmes Tropicaux, Antananarivo, Madagascar
| | - Elinambinina Rajaonarifara
- MIVEGEC, Ecole Pierre Louis de Santé Publique, Université de Montpellier, CNRS, IRD, Montpellier, France
- PIVOT, Ranomafana, Madagascar
- Sorbonne Universite, Paris, France
| | - Calistus N. Ngonghala
- Department of Mathematics and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Benjamin Roche
- MIVEGEC, Ecole Pierre Louis de Santé Publique, Université de Montpellier, CNRS, IRD, Montpellier, France
- IRD, Sorbonne Université, UMMISCO, Bondy, France
- Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Matthew H. Bonds
- PIVOT, Ranomafana, Madagascar
- Harvard Medical School, Boston, MA, USA
| | - Julio Rakotonirina
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
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23
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Cordier LF, Kalaris K, Rakotonanahary RJL, Rakotonirina L, Haruna J, Mayfield A, Marovavy L, McCarty MG, Tsirinomen'ny Aina A, Ratsimbazafy B, Razafinjato B, Loyd T, Ihantamalala F, Garchitorena A, Bonds MH, Finnegan KE. Networks of Care in Rural Madagascar for Achieving Universal Health Coverage in Ifanadiana District. Health Syst Reform 2020; 6:e1841437. [PMID: 33314984 DOI: 10.1080/23288604.2020.1841437] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Health care is most effective when a patient's basic primary care needs are met as close to home as possible, with advanced care accessible when needed. In Ifanadiana District, Madagascar, a collaboration between the Ministry of Public Health (MoPH) and PIVOT, a non-governmental organization (NGO), fosters Networks of Care (NOC) to support high-quality, patient-centered care. The district's health system has three levels of care: community, health center, district hospital; a regional hospital is available for tertiary care services. We explore the MoPH/PIVOT collaboration through a case study which focuses on noteworthy elements of the collaboration across the four NOC domains: (I) agreement and enabling environment, (II) operational standards, (III) quality, efficiency, and responsibility, (IV) learning and adaptation. Under Domain I, we describe formal agreements between the MoPH and PIVOT and the process for engaging communities in creating effective NOC. Domain II discusses patient referral across levels of the health system and improvements to facility readiness and service availability. Under Domain III the collaboration prioritizes communication and supervision to support clinical quality, and social support for patients. Domain IV focuses on evaluation, research, and the use of data to modify programs to better meet community needs. The case study, organized by the domains of the NOC framework, demonstrates that a collaboration between the MoPH and an NGO can create effective NOC in a remote district with limited accessibility and advance the country's agenda to achieve universal health coverage.
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Affiliation(s)
| | - Katherine Kalaris
- Maternal Newborn and Reproductive Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | | | | | | | - Alishya Mayfield
- NGO PIVOT , Ranomafana, Madagascar.,Department of Global Health Equity, Brigham and Women's Hospital , Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School , Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - Andres Garchitorena
- NGO PIVOT , Ranomafana, Madagascar.,MIVEGEC Laboratory, University of Montpellier, Centre National de la Recherche Scientifique, Institut de Recherche pour le Développement , Antananarivo, Madagascar
| | - Matthew H Bonds
- NGO PIVOT , Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School , Boston, Massachusetts, USA
| | - Karen E Finnegan
- NGO PIVOT , Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School , Boston, Massachusetts, USA
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24
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Ihantamalala FA, Herbreteau V, Révillion C, Randriamihaja M, Commins J, Andréambeloson T, Rafenoarimalala FH, Randrianambinina A, Cordier LF, Bonds MH, Garchitorena A. Improving geographical accessibility modeling for operational use by local health actors. Int J Health Geogr 2020; 19:27. [PMID: 32631348 PMCID: PMC7339519 DOI: 10.1186/s12942-020-00220-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 03/11/2020] [Accepted: 06/29/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations. METHODS We used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest routes from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest routes estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny. RESULTS We mapped over 100,000 buildings, 23,000 km of footpaths, and 4925 residential areas throughout Ifanadiana district; these data are freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than 1 h away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 h away, and vulnerable populations across the district with poor geographical access (> 1 h) to both PHCs and CHSs. CONCLUSION Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage (UHC) in rural areas throughout the world.
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Affiliation(s)
- Felana Angella Ihantamalala
- NGO PIVOT, Ranomafana, Madagascar. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - Christophe Révillion
- Université de La Réunion, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Saint-Pierre, La Réunion, France
| | - Mauricianot Randriamihaja
- NGO PIVOT, Ranomafana, Madagascar.,School of Management and Technological Innovation, University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Jérémy Commins
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - Tanjona Andréambeloson
- NGO PIVOT, Ranomafana, Madagascar.,School of Management and Technological Innovation, University of Fianarantsoa, Fianarantsoa, Madagascar
| | | | | | | | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Andres Garchitorena
- NGO PIVOT, Ranomafana, Madagascar.,MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
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Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364. [PMID: 32360770 PMCID: PMC7252217 DOI: 10.1016/j.mbs.2020.108364] [Citation(s) in RCA: 278] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 01/24/2023]
Abstract
A pandemic of a novel Coronavirus emerged in December of 2019 (COVID-19), causing devastating public health impact across the world. In the absence of a safe and effective vaccine or antivirals, strategies for controlling and mitigating the burden of the pandemic are focused on non-pharmaceutical interventions, such as social-distancing, contact-tracing, quarantine, isolation, and the use of face-masks in public. We develop a new mathematical model for assessing the population-level impact of the aforementioned control and mitigation strategies. Rigorous analysis of the model shows that the disease-free equilibrium is locally-asymptotically stable if a certain epidemiological threshold, known as the reproduction number (denoted by ℛc), is less than unity. Simulations of the model, using data relevant to COVID-19 transmission dynamics in the US state of New York and the entire US, show that the pandemic burden will peak in mid and late April, respectively. The worst-case scenario projections for cumulative mortality (based on the baseline levels of anti-COVID non-pharmaceutical interventions considered in the study) decrease dramatically by 80% and 64%, respectively, if the strict social-distancing measures implemented are maintained until the end of May or June, 2020. The duration and timing of the relaxation or termination of the strict social-distancing measures are crucially-important in determining the future trajectory of the COVID-19 pandemic. This study shows that early termination of the strict social-distancing measures could trigger a devastating second wave with burden similar to those projected before the onset of the strict social-distancing measures were implemented. The use of efficacious face-masks (such as surgical masks, with estimated efficacy ≥ 70%) in public could lead to the elimination of the pandemic if at least 70% of the residents of New York state use such masks in public consistently (nationwide, a compliance of at least 80% will be required using such masks). The use of low efficacy masks, such as cloth masks (of estimated efficacy less than 30%), could also lead to significant reduction of COVID-19 burden (albeit, they are not able to lead to elimination). Combining low efficacy masks with improved levels of the other anti-COVID-19 intervention strategies can lead to the elimination of the pandemic. This study emphasizes the important role social-distancing plays in curtailing the burden of COVID-19. Increases in the adherence level of social-distancing protocols result in dramatic reduction of the burden of the pandemic, and the timely implementation of social-distancing measures in numerous states of the US may have averted a catastrophic outcome with respect to the burden of COVID-19. Using face-masks in public (including the low efficacy cloth masks) is very useful in minimizing community transmission and burden of COVID-19, provided their coverage level is high. The masks coverage needed to eliminate COVID-19 decreases if the masks-based intervention is combined with the strict social-distancing strategy.
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Affiliation(s)
| | - Enahoro Iboi
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ, 85287, USA
| | - Steffen Eikenberry
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ, 85287, USA
| | - Matthew Scotch
- Biodesign Institute, Arizona State University, Tempe, AZ, 85287, USA
| | | | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Abba B Gumel
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ, 85287, USA.
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26
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Ballard M, Bancroft E, Nesbit J, Johnson A, Holeman I, Foth J, Rogers D, Yang J, Nardella J, Olsen H, Raghavan M, Panjabi R, Alban R, Malaba S, Christiansen M, Rapp S, Schechter J, Aylward P, Rogers A, Sebisaho J, Ako C, Choudhury N, Westgate C, Mbeya J, Schwarz R, Bonds MH, Adamjee R, Bishop J, Yembrick A, Flood D, McLaughlin M, Palazuelos D. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health 2020; 5:e002550. [PMID: 32503889 PMCID: PMC7298684 DOI: 10.1136/bmjgh-2020-002550] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/03/2022] Open
Abstract
COVID-19 disproportionately affects the poor and vulnerable. Community health workers are poised to play a pivotal role in fighting the pandemic, especially in countries with less resilient health systems. Drawing from practitioner expertise across four WHO regions, this article outlines the targeted actions needed at different stages of the pandemic to achieve the following goals: (1) PROTECT healthcare workers, (2) INTERRUPT the virus, (3) MAINTAIN existing healthcare services while surging their capacity, and (4) SHIELD the most vulnerable from socioeconomic shocks. While decisive action must be taken now to blunt the impact of the pandemic in countries likely to be hit the hardest, many of the investments in the supply chain, compensation, dedicated supervision, continuous training and performance management necessary for rapid community response in a pandemic are the same as those required to achieve universal healthcare and prevent the next epidemic.
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Affiliation(s)
- Madeleine Ballard
- Community Health Impact Coalition, New York, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Josh Nesbit
- Medic Mobile, San Francisco, California, USA
| | - Ari Johnson
- Muso, Bamako, Mali
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Isaac Holeman
- Medic Mobile, San Francisco, California, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | | | - Helen Olsen
- Medic Mobile, San Francisco, California, USA
| | | | - Raj Panjabi
- Last Mile Health, Monrovia, Liberia
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | - Nandini Choudhury
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- POSSIBLE, New York, New York, USA
| | - Carey Westgate
- Community Health Impact Coalition, New York, New York, USA
| | | | - Ryan Schwarz
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- POSSIBLE, New York, New York, USA
| | - Matthew H Bonds
- Harvard Medical School Department of Global Health and Social Medicine, Blavatnik Institute, Boston, Massachusetts, USA
- PIVOT, Ranomafana, Madagascar
| | | | | | | | - David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Daniel Palazuelos
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
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27
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Miller AC, Garchitorena A, Rabemananjara F, Cordier L, Randriamanambintsoa M, Rabeza V, Razanadrakoto HTR, Rakoto Ramakasoa R, RamahefarisonTiana O, Ratsimbazafy BN, Ouenzar MA, Bonds MH, Ratsifandrihamanana L. Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar. BMC Pediatr 2020; 20:108. [PMID: 32138722 PMCID: PMC7059323 DOI: 10.1186/s12887-020-1985-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background 50% of Malagasy children have moderate to severe stunting. In 2016, a new 10 year National Nutrition Action Plan (PNAN III) was initiated to help address stunting and developmental delay. We report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of Ifanadiana in southeastern Madagascar in 2016. Methods The data are from a cross-sectional analysis of the 2016 wave of IHOPE panel data (a population-representative cohort study begun in 2014). We interviewed women ages 15–49 using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. We analyzed ECDI data using standardized z scores for relative relationships for 2 outcomes: at-risk-for-delay vs. an international standard, and lower-development-than-peers if ECDI z scores were > 1 standard deviation below study mean. Covariates included demographics, adult involvement, household environment, and selected child health factors. Variables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level. Results Of 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. This was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had > = 4 stimulation activities in past 3 days. Greater paternal engagement (OR 1.5 (1.09, 2.07)) was associated with increased delay vs. international norms. Adolescent motherhood (OR. 4.09 (1.40, 11.87)) decreased children’s development vs. peers. Engagement from a non-parental adult reduced odds of delay for both outcomes (OR (95%CI = 0.76 (0.63, 0.91) & 0.27 (0.15, 0 48) respectively). Stunting was not associated with delay risk (1.36 (0.85, 2.15) or low development (0.92 (0.48, 1.78)) when controlling for other factors. Conclusions In this setting of high child malnutrition, stunting is not independently associated with developmental risk. A low proportion of children receive developmentally supportive stimulation from adults, but non-parent adults provide more stimulation in general than either mother or father. Stimulation from non-parent adults is associated with lower odds of delay.
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Affiliation(s)
- Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
| | - Andres Garchitorena
- MIVEGEC, Univ Montpellier, CNRS, IRD, Montpellier, France.,PIVOT, Ranomfana, Madagascar
| | | | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Victor Rabeza
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | - Olivier RamahefarisonTiana
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.,PIVOT, Ranomfana, Madagascar
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Brummitt CD, Gómez-Liévano A, Hausmann R, Bonds MH. Machine-learned patterns suggest that diversification drives economic development. J R Soc Interface 2020; 17:20190283. [PMID: 31910774 DOI: 10.1098/rsif.2019.0283] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We combine a sequence of machine-learning techniques, together called Principal Smooth-Dynamics Analysis (PriSDA), to identify patterns in the dynamics of complex systems. Here, we deploy this method on the task of automating the development of new theory of economic growth. Traditionally, economic growth is modelled with a few aggregate quantities derived from simplified theoretical models. PriSDA, by contrast, identifies important quantities. Applied to 55 years of data on countries' exports, PriSDA finds that what most distinguishes countries' export baskets is their diversity, with extra weight assigned to more sophisticated products. The weights are consistent with previous measures of product complexity. The second dimension of variation is proficiency in machinery relative to agriculture. PriSDA then infers the dynamics of these two quantities and of per capita income. The inferred model predicts that diversification drives growth in income, that diversified middle-income countries will grow the fastest, and that countries will converge onto intermediate levels of income and specialization. PriSDA is generalizable and may illuminate dynamics of elusive quantities such as diversity and complexity in other natural and social systems.
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Affiliation(s)
- Charles D Brummitt
- Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | | | - Ricardo Hausmann
- Growth Lab at Harvard University, Cambridge, MA, USA.,Center for International Development, Harvard Kennedy School, Cambridge, MA 02138, USA.,Santa Fe Institute, Santa Fe, NM 87501, USA
| | - Matthew H Bonds
- Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
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29
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Wild H, Glowacki L, Maples S, Mejía-Guevara I, Krystosik A, Bonds MH, Hiruy A, LaBeaud AD, Barry M. Making Pastoralists Count: Geospatial Methods for the Health Surveillance of Nomadic Populations. Am J Trop Med Hyg 2019; 101:661-669. [PMID: 31436151 PMCID: PMC6726942 DOI: 10.4269/ajtmh.18-1009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 12/27/2018] [Accepted: 06/18/2019] [Indexed: 11/07/2022] Open
Abstract
Nomadic pastoralists are among the world's hardest-to-reach and least served populations. Pastoralist communities are difficult to capture in household surveys because of factors including their high degree of mobility over remote terrain, fluid domestic arrangements, and cultural barriers. Most surveys use census-based sampling frames which do not accurately capture the demographic and health parameters of nomadic populations. As a result, pastoralists are "invisible" in population data such as the Demographic and Health Surveys (DHS). By combining remote sensing and geospatial analysis, we developed a sampling strategy designed to capture the current distribution of nomadic populations. We then implemented this sampling frame to survey a population of mobile pastoralists in southwest Ethiopia, focusing on maternal and child health (MCH) indicators. Using standardized instruments from DHS questionnaires, we draw comparisons with regional and national data finding disparities with DHS data in core MCH indicators, including vaccination coverage, skilled birth attendance, and nutritional status. Our field validation demonstrates that this method is a logistically feasible alternative to conventional sampling frames and may be used at the population level. Geospatial sampling methods provide cost-affordable and logistically feasible strategies for sampling mobile populations, a crucial first step toward reaching these groups with health services.
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Affiliation(s)
- Hannah Wild
- Stanford University School of Medicine, Stanford, California
| | - Luke Glowacki
- Department of Anthropology, Pennsylvania State University
| | - Stace Maples
- Stanford Geospatial Center, Stanford University, Stanford, California
| | - Iván Mejía-Guevara
- Department of Biology, Stanford University, Stanford, California
- Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California
| | - Amy Krystosik
- Division of Infectious Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Abiy Hiruy
- Pathfinder International, Addis Ababa, Ethiopia
| | - A. Desiree LaBeaud
- Division of Infectious Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Michele Barry
- The Center for Innovation in Global Health, Stanford University, Stanford, California
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30
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Ezran C, Bonds MH, Miller AC, Cordier LF, Haruna J, Mwanawabenea D, Randriamanambintsoa M, Razanadrakato HTR, Ouenzar MA, Razafinjato BR, Murray M, Garchitorena A. Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar: A longitudinal cohort study. PLoS Med 2019; 16:e1002869. [PMID: 31430286 PMCID: PMC6701767 DOI: 10.1371/journal.pmed.1002869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In order to reach the health-related Sustainable Development Goals (SDGs) by 2030, gains attained in access to primary healthcare must be matched by gains in the quality of services delivered. Despite the broad consensus around the need to address quality, studies on the impact of health system strengthening (HSS) have focused predominantly on measures of healthcare access. Here, we examine changes in the content of maternal and child care as a proxy for healthcare quality, to better evaluate the effectiveness of an HSS intervention in a rural district of Madagascar. The intervention aimed at improving system readiness at all levels of care (community health, primary health centers, district hospital) through facility renovations, staffing, equipment, and training, while removing logistical and financial barriers to medical care (e.g., ambulance network and user-fee exemptions). METHODS AND FINDINGS We carried out a district-representative open longitudinal cohort study, with surveys administered to 1,522 households in the Ifanadiana district of Madagascar at the start of the HSS intervention in 2014, and again to 1,514 households in 2016. We examined changes in healthcare seeking behavior and outputs for sick-child care among children <5 years old, as well as for antenatal care and perinatal care among women aged 15-49. We used a difference-in-differences (DiD) analysis to compare trends between the intervention group (i.e., people living inside the HSS catchment area) and the non-intervention comparison group (i.e., the rest of the district). In addition, we used health facility-based surveys, monitoring service availability and readiness, to assess changes in the operational capacities of facilities supported by the intervention. The cohort study included 657 and 411 children (mean age = 2 years) reported to be ill in the 2014 and 2016 surveys, respectively (27.8% and 23.8% in the intervention group for each survey), as well as 552 and 524 women (mean age = 28 years) reported to have a live birth within the previous two years in the 2014 and 2016 surveys, respectively (31.5% and 29.6% in the intervention group for each survey). Over the two-year study period, the proportion of people who reported seeking care at health facilities experienced a relative change of +51.2% (from 41.4% in 2014 to 62.5% in 2016) and -7.1% (from 30.0% to 27.9%) in the intervention and non-intervention groups, respectively, for sick-child care (DiD p-value = 0.01); +11.4% (from 78.3% to 87.2%), and +10.3% (from 67.3% to 74.2%) for antenatal care (p-value = 0.75); and +66.2% (from 23.1% to 38.3%) and +28.9% (from 13.9% to 17.9%) for perinatal care (p-value = 0.13). Most indicators of care content, including rates of medication prescription and diagnostic test administration, appeared to increase more in the intervention compared to in the non-intervention group for the three areas of care we assessed. The reported prescription rate for oral rehydration therapy among children with diarrhea changed by +68.5% (from 29.6% to 49.9%) and -23.2% (from 17.8% to 13.7%) in the intervention and non-intervention groups, respectively (p-value = 0.05). However, trends observed in the care content varied widely by indicator and did not always match the large apparent increases observed in care seeking behavior, particularly for antenatal care, reflecting important gaps in the provision of essential health services for individuals who sought care. The main limitation of this study is that the intervention catchment was not randomly allocated, and some demographic indicators were better for this group at baseline than for the rest of the district, which could have impacted the trends observed. CONCLUSION Using a district-representative longitudinal cohort to assess the content of care delivered to the population, we found a substantial increase over the two-year study period in the prescription rate for ill children and in all World Health Organization (WHO)-recommended perinatal care outputs assessed in the intervention group, with more modest changes observed in the non-intervention group. Despite improvements associated with the HSS intervention, this study highlights the need for further quality improvement in certain areas of the district's healthcare system. We show how content of care, measured through standard population-based surveys, can be used as a component of HSS impact evaluations, enabling healthcare leaders to track progress as well as identify and address specific gaps in the provision of services that extend beyond care access.
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Affiliation(s)
- Camille Ezran
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail: (CE); (AG)
| | - Matthew H. Bonds
- PIVOT, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | | | | | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Hery-Tiana R. Razanadrakato
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | - Andres Garchitorena
- PIVOT, Ranomafana, Madagascar
- MIVEGEC, Univ Montpellier, CNRS, IRD, Montpellier, France
- * E-mail: (CE); (AG)
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31
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Miller AC, Garchitorena A, Rabeza V, Randriamanambintsoa M, Rahaniraka Razanadrakato HT, Cordier L, Ouenzar MA, Murray MB, Thomson DR, Bonds MH. Cohort Profile: Ifanadiana Health Outcomes and Prosperity longitudinal Evaluation (IHOPE). Int J Epidemiol 2019; 47:1394-1395e. [PMID: 29939260 DOI: 10.1093/ije/dyy099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Andres Garchitorena
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,PIVOT, Boston, MA, USA.,UMR 224 MIVEGEC, Institut de Recherche pour le Développement, Montpellier, France
| | - Victor Rabeza
- Institut National de la Statistique, Direction de la Demographie et des Statistiques Sociales, Antananarivo, Madagascar
| | - Marius Randriamanambintsoa
- Institut National de la Statistique, Direction de la Demographie et des Statistiques Sociales, Antananarivo, Madagascar
| | | | | | | | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Dana R Thomson
- Social Statistics Department, University of Southampton, Southampton, UK
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,PIVOT, Boston, MA, USA
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32
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McCuskee S, Garchitorena A, Miller AC, Hall L, Ouenzar MA, Rabeza VR, Ramananjato RH, Razanadrakato HTR, Randriamanambintsoa M, Barry M, Bonds MH. Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention. Glob Health Action 2018; 11:1452357. [PMID: 29595379 PMCID: PMC5912446 DOI: 10.1080/16549716.2018.1452357] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Child malnutrition, a leading cause of death and disability worldwide, is particularly severe in Madagascar, where 47% of children under 5 years are stunted (low height-for-age) and 8% are wasted (low weight-for-height). Widespread poverty and a weak health system have hindered attempts to implement life-saving malnutrition interventions in Madagascar during critical periods for growth faltering. Objective: This study aimed to shed light on the most important factors associated with child malnutrition, both acute and chronic, and the timing of growth faltering, in Ifanadiana, a rural district of Madagascar. Methods: We analyzed data from a 2014 district-representative cluster household survey, which had information on 1175 children ages 6 months to 5 years. We studied the effect of child health, birth history, maternal and paternal health and education, and household wealth and sanitation on child nutritional status. Variables associated with stunting and wasting were modeled separately in multivariate logistic regressions. Growth faltering was modeled by age range. All analyses were survey-adjusted. Results: Stunting was associated with increasing child age (OR = 1.03 (95%CI 1.02–1.04) for each additional month), very small birth size (OR = 2.32 (1.24–4.32)), low maternal weight (OR = 0.94 (0.91–0.97) for each kilogram, kg) and height (OR = 0.95 (0.92–0.99) for each centimeter), and low paternal height (OR = 0.95 (0.92–0.98)). Wasting was associated with younger child age (OR = 0.98 (0.97–0.99)), very small birth size (OR = 2.48 (1.23–4.99)), and low maternal BMI (OR = 0.84 (0.75–0.94) for each kg/m2). Height-for-age faltered rapidly before 24 months, then slowly until age 5 years, whereas weight-for-height faltered rapidly before 12 months, then recovered gradually until age 5 years but did not reach the median. Conclusion: Intergenerational transmission of growth faltering and early life exposures may be important determinants of malnutrition in Ifanadiana. Timing of growth faltering, in the first 1000 days, is similar to international populations; however, child growth does not recover to the median.
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Affiliation(s)
- Sarah McCuskee
- a Stanford University School of Medicine , Stanford , CA , USA
| | - Andres Garchitorena
- b Harvard Medical School , Department of Global Health and Social Medicine , Boston , MA , USA.,c PIVOT , Ranomafana , Madagascar
| | - Ann C Miller
- b Harvard Medical School , Department of Global Health and Social Medicine , Boston , MA , USA.,c PIVOT , Ranomafana , Madagascar
| | - Lara Hall
- d Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA
| | | | - Victor R Rabeza
- e Institut National de la Statistique , Direction de la Demographie et de les Statistiques Sociales , Antananarivo , Madagascar
| | - Ranto H Ramananjato
- e Institut National de la Statistique , Direction de la Demographie et de les Statistiques Sociales , Antananarivo , Madagascar.,f UNICEF , Madagascar Country Office , Antananarivo , Madagascar
| | | | - Marius Randriamanambintsoa
- e Institut National de la Statistique , Direction de la Demographie et de les Statistiques Sociales , Antananarivo , Madagascar
| | - Michele Barry
- g Center for Innovation in Global Health , Stanford University , Stanford , CA , USA.,h Office of the Dean , Stanford University School of Medicine , Stanford , CA , USA
| | - Matthew H Bonds
- b Harvard Medical School , Department of Global Health and Social Medicine , Boston , MA , USA.,c PIVOT , Ranomafana , Madagascar
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33
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Bonds MH, Rich ML. Integrated health system strengthening can generate rapid population impacts that can be replicated: lessons from Rwanda to Madagascar. BMJ Glob Health 2018; 3:e000976. [PMID: 30294462 PMCID: PMC6169669 DOI: 10.1136/bmjgh-2018-000976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/01/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Matthew H Bonds
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael L Rich
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Garchitorena A, Raza-Fanomezanjanahary EM, Mioramalala SA, Chesnais CB, Ratsimbasoa CA, Ramarosata H, Bonds MH, Rabenantoandro H. Towards elimination of lymphatic filariasis in southeastern Madagascar: Successes and challenges for interrupting transmission. PLoS Negl Trop Dis 2018; 12:e0006780. [PMID: 30222758 PMCID: PMC6160210 DOI: 10.1371/journal.pntd.0006780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/03/2018] [Revised: 09/27/2018] [Accepted: 08/23/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction A global strategy of mass drug administration (MDA) has greatly reduced the burden of lymphatic filariasis (LF) in endemic countries. In Madagascar, the National Programme to eliminate LF has scaled-up annual MDA of albendazole and diethylcarbamazine across the country in the last decade, but its impact on LF transmission has never been reported. The objective of this study was to evaluate progress towards LF elimination in southeastern Madagascar. Methods Three different surveys were carried out in parallel in four health districts of the Vatovavy Fitovinany region in 2016: i) a school-based transmission assessment survey (TAS) in the districts of Manakara Atsimo, Mananjary, and Vohipeno (following a successful pre-TAS in 2013); ii) a district-representative community prevalence survey in Ifanadiana district; and iii) a community prevalence survey in sentinel and spot-check sites of these four districts. LF infection was assessed using the Alere Filariasis Test Strips, which detect circulating filarial antigens (CFA) of adult worms. A brief knowledge, attitudes and practices questionnaire was included in the community surveys. Principal findings None of the 1,825 children sampled in the TAS, and only one in 1,306 children from sentinel and spot-check sites, tested positive to CFA. However, CFA prevalence rate in individuals older than 15 years was still high in two of these three districts, at 3.5 and 9.7% in Mananjary and Vohipeno, respectively. Overall CFA prevalence in sentinel and spot-check sites of these three districts was 2.80% (N = 2,707), but only two individuals had detectable levels of microfilaraemia (0.06%). Prevalence rate estimates for Ifanadiana were substantially higher in the district-representative survey (15.8%; N = 545) than in sentinel and spot-check sites (0.8%; N = 618). Only 51.2% of individuals surveyed in these four districts reported taking MDA in the last year, and 42.2% reported knowing about LF. Conclusions Although TAS results suggest that MDA can be stopped in three districts of southeastern Madagascar, the adult population still presents high CFA prevalence levels. This discordance raises important questions about the TAS procedures and the interpretation of their results. Lymphatic filariasis is a neglected disease with chronic disabling consequences. Endemic countries have reduced lymphatic filariasis transmission through a strategy of annual rounds of mass drug administration (MDA), but the impact of such strategy has not yet been reported for Madagascar. In this study we conducted three different surveys and used rapid diagnostic tests to evaluate lymphatic filariasis transmission in four health districts of southeastern Madagascar. This included a school-based transmission assessment survey (TAS), the international gold standard to help national programmes confirm that they have interrupted lymphatic filariasis transmission, and two complementary community-based surveys. Our TAS results suggested that MDA could be stopped in three districts, confirming the consistent decline in lymphatic filariasis observed in recent years. However, the other two surveys revealed that the adult population still had high prevalence levels. This discordance raises questions about the TAS procedures and the interpretation of their results in contexts where, like in Madagascar, implementation of MDA is different for school age children than for the rest of the population.
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Affiliation(s)
- Andres Garchitorena
- UMR 224 MIVEGEC, Institut de Recherche pour le Développement, Montpellier, France
- PIVOT, Ifanadiana, Madagascar
- * E-mail:
| | - Estelle M. Raza-Fanomezanjanahary
- Institut National de la Sante Publique et Communautaire, – Ministère de la Santé Publique, Ministère de l’Enseignement Supérieur et de la Recherche Scientifique, Antananarivo, Madagascar
| | - Sedera A. Mioramalala
- Direction de lutte contre le paludisme, – Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Cédric B. Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| | - Claude A. Ratsimbasoa
- Direction de lutte contre le paludisme, – Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Herinirina Ramarosata
- Institut National de la Sante Publique et Communautaire, – Ministère de la Santé Publique, Ministère de l’Enseignement Supérieur et de la Recherche Scientifique, Antananarivo, Madagascar
| | - Matthew H. Bonds
- PIVOT, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Holivololona Rabenantoandro
- Service de Lutte contre les Maladies Epidémiques et Négligées – Ministère de la Santé Publique, Antananarivo, Madagascar
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Miller AC, Ramananjato RH, Garchitorena A, Rabeza VR, Gikic D, Cripps A, Cordier L, Rahaniraka Razanadrakato HT, Randriamanambintsoa M, Hall L, Murray M, Safara Razanavololo F, Rich ML, Bonds MH. Baseline population health conditions ahead of a health system strengthening program in rural Madagascar. Glob Health Action 2018. [PMID: 28621206 PMCID: PMC5496087 DOI: 10.1080/16549716.2017.1329961] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Indexed: 11/10/2022] Open
Abstract
Background: A model health district was initiated through a program of health system strengthening (HSS) in Ifanadiana District of southeastern Madagascar in 2014. We report population health indicators prior to initiation of the program. Methods: A representative household survey based on the Demographic Health Survey was conducted using a two-stage cluster sampling design in two strata – the initial program catchment area and the future catchment area. Chi-squared and t-tests were used to compare data by stratum, using appropriate sampling weights. Madagascar data for comparison were taken from a 2013 national study. Results: 1522 households were surveyed, representing 8310 individuals including 1635 women ages 15–49, 1685 men ages 15–59 and 1251 children under age 5. Maternal mortality rates in the district are 1044/100,000. 81% of women’s last childbirth deliveries were in the home; only 20% of deliveries were attended by a doctor or nurse/midwife (not different by stratum). 9.3% of women had their first birth by age 15, and 29.5% by age 18. Under-5 mortality rate is high: 145/1000 live births vs. 62/1000 nationally. 34.6% of children received all recommended vaccines by age 12 months (compared to 51.5% in Madagascar overall). In the 2 weeks prior to interview, approximately 28% of children under age 5 had acute respiratory infections of whom 34.7% were taken for care, and 14% of children had diarrhea of whom 56.6% were taken for care. Under-5 mortality, illness, care-seeking and vaccination rates were not significantly different between strata. Conclusions: Indicators of population health and health care-seeking reveal low use of the formal health system, which could benefit from HSS. Data from this survey and from a longitudinal follow-up study will be used to target needed interventions, to assess change in the district and the impact of HSS on individual households and the population of the district.
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Affiliation(s)
- Ann C Miller
- a Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA.,b PIVOT , Boston , MA , USA
| | - Ranto H Ramananjato
- c Institut National de la Statistique, Direction de la Demographie et de les Statistiques Sociales , Antananarivo , Madagascar
| | - Andres Garchitorena
- a Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA.,b PIVOT , Boston , MA , USA
| | - Victor R Rabeza
- c Institut National de la Statistique, Direction de la Demographie et de les Statistiques Sociales , Antananarivo , Madagascar
| | | | | | | | | | - Marius Randriamanambintsoa
- c Institut National de la Statistique, Direction de la Demographie et de les Statistiques Sociales , Antananarivo , Madagascar
| | | | - Megan Murray
- a Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
| | | | - Michael L Rich
- a Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
| | - Matthew H Bonds
- a Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA.,b PIVOT , Boston , MA , USA.,e Department of Medicine , Stanford School of Medicine , Stanford , CA , USA
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Tesla B, Demakovsky LR, Mordecai EA, Ryan SJ, Bonds MH, Ngonghala CN, Brindley MA, Murdock CC. Temperature drives Zika virus transmission: evidence from empirical and mathematical models. Proc Biol Sci 2018; 285:20180795. [PMID: 30111605 PMCID: PMC6111177 DOI: 10.1098/rspb.2018.0795] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022] Open
Abstract
Temperature is a strong driver of vector-borne disease transmission. Yet, for emerging arboviruses we lack fundamental knowledge on the relationship between transmission and temperature. Current models rely on the untested assumption that Zika virus responds similarly to dengue virus, potentially limiting our ability to accurately predict the spread of Zika. We conducted experiments to estimate the thermal performance of Zika virus (ZIKV) in field-derived Aedes aegypti across eight constant temperatures. We observed strong, unimodal effects of temperature on vector competence, extrinsic incubation period and mosquito survival. We used thermal responses of these traits to update an existing temperature-dependent model to infer temperature effects on ZIKV transmission. ZIKV transmission was optimized at 29°C, and had a thermal range of 22.7°C-34.7°C. Thus, as temperatures move towards the predicted thermal optimum (29°C) owing to climate change, urbanization or seasonality, Zika could expand north and into longer seasons. By contrast, areas that are near the thermal optimum were predicted to experience a decrease in overall environmental suitability. We also demonstrate that the predicted thermal minimum for Zika transmission is 5°C warmer than that of dengue, and current global estimates on the environmental suitability for Zika are greatly over-predicting its possible range.
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Affiliation(s)
- Blanka Tesla
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | - Leah R Demakovsky
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | | | - Sadie J Ryan
- Quantitative Disease Ecology and Conservation Laboratory, Department of Geography, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- College of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Melinda A Brindley
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- Department of Population Health, University of Georgia, Athens, GA, USA
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, USA
| | - Courtney C Murdock
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, USA
- Odum School of Ecology, University of Georgia, Athens, GA, USA
- Center of Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
- River Basin Center, University of Georgia, Athens, GA, USA
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Garchitorena A, Miller AC, Cordier LF, Ramananjato R, Rabeza VR, Murray M, Cripps A, Hall L, Farmer P, Rich M, Orlan AV, Rabemampionona A, Rakotozafy G, Randriantsimaniry D, Gikic D, Bonds MH. In Madagascar, Use Of Health Care Services Increased When Fees Were Removed: Lessons For Universal Health Coverage. Health Aff (Millwood) 2018; 36:1443-1451. [PMID: 28784737 DOI: 10.1377/hlthaff.2016.1419] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 11/05/2022]
Abstract
Despite overwhelming burdens of disease, health care access in most developing countries is extremely low. As governments work toward achieving universal health coverage, evidence on appropriate interventions to expand access in rural populations is critical for informing policies. Using a combination of population and health system data, we evaluated the impact of two pilot fee exemption interventions in a rural area of Madagascar. We found that fewer than one-third of people in need of health care accessed treatment when point-of-service fees were in place. However, when fee exemptions were introduced for targeted medicines and services, the use of health care increased by 65 percent for all patients, 52 percent for children under age five, and over 25 percent for maternity consultations. These effects were sustained at an average direct cost of US$0.60 per patient. The pilot interventions can become a key element of universal health care in Madagascar with the support of external donors.
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Affiliation(s)
- Andres Garchitorena
- Andres Garchitorena is a postdoctoral fellow in the Department of Global Health and Social Medicine, Harvard Medical School, in Boston, Massachusetts
| | - Ann C Miller
- Ann C. Miller is a principal associate in the Department of Global Health and Social Medicine, Harvard Medical School
| | - Laura F Cordier
- Laura F. Cordier is monitoring and evaluation manager at the nongovernmental organization (NGO) PIVOT in Ranomafana, Madagascar
| | - Ranto Ramananjato
- Ranto Ramananjato is a statistician at the Institut National de la Statistique (INSTAT), in Antananarivo, Madagascar
| | | | - Megan Murray
- Megan Murray is a professor in the Department of Global Health and Social Medicine, Harvard Medical School
| | - Amber Cripps
- Amber Cripps is former deputy country director at the NGO PIVOT
| | - Laura Hall
- Laura Hall is former medical director at the NGO PIVOT
| | - Paul Farmer
- Paul Farmer is a professor in the Department of Global Health and Social Medicine, Harvard Medical School
| | - Michael Rich
- Michael Rich is an associate professor in the Department of Global Health and Social Medicine, Harvard Medical School
| | - Arthur Velo Orlan
- Arthur Velo Orlan is a program manager at the Madagascar Ministry of Public Health, in Antananarivo
| | - Alexandre Rabemampionona
- Alexandre Rabemampionona is former medical inspector for Ifanadiana at the Madagascar Ministry of Public Health
| | - Germain Rakotozafy
- Germain Rakotozafy is regional health director for Vatovavy-Fitovinany at the Madagascar Ministry of Public Health
| | | | - Djordje Gikic
- Djordje Gikic is former country director at the NGO PIVOT
| | - Matthew H Bonds
- Matthew H. Bonds is an associate professor in the Department of Global Health and Social Medicine, Harvard Medical School
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38
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Garchitorena A, Miller AC, Cordier LF, Rabeza VR, Randriamanambintsoa M, Razanadrakato HTR, Hall L, Gikic D, Haruna J, McCarty M, Randrianambinina A, Thomson DR, Atwood S, Rich ML, Murray MB, Ratsirarson J, Ouenzar MA, Bonds MH. Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar. BMJ Glob Health 2018; 3:e000762. [PMID: 29915670 PMCID: PMC6001915 DOI: 10.1136/bmjgh-2018-000762] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Sustainable Development Goals framed an unprecedented commitment to achieve global convergence in child and maternal mortality rates through 2030. To meet those targets, essential health services must be scaled via integration with strengthened health systems. This is especially urgent in Madagascar, the country with the lowest level of financing for health in the world. Here, we present an interim evaluation of the first 2 years of a district-level health system strengthening (HSS) initiative in rural Madagascar, using estimates of intervention coverage and mortality rates from a district-wide longitudinal cohort. METHODS We carried out a district representative household survey at baseline of the HSS intervention in over 1500 households in Ifanadiana district. The first follow-up was after the first 2 years of the initiative. For each survey, we estimated maternal, newborn and child health (MNCH) coverage, healthcare inequalities and child mortality rates both in the initial intervention catchment area and in the rest of the district. We evaluated changes between the two areas through difference-in-differences analyses. We estimated annual changes in health centre per capita utilisation from 2013 to 2016. RESULTS The intervention was associated with 19.1% and 36.4% decreases in under-five and neonatal mortality, respectively, although these were not statistically significant. The composite coverage index (a summary measure of MNCH coverage) increased by 30.1%, with a notable 63% increase in deliveries in health facilities. Improvements in coverage were substantially larger in the HSS catchment area and led to an overall reduction in healthcare inequalities. Health centre utilisation rates in the catchment tripled for most types of care during the study period. CONCLUSION At the earliest stages of an HSS intervention, the rapid improvements observed for Ifanadiana add to preliminary evidence supporting the untapped and poorly understood potential of integrated HSS interventions on population health.
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Affiliation(s)
- Andres Garchitorena
- UMR 224 MIVEGEC, Institut de Recherche pour le Developpement, Montpellier, France
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- PIVOT, Ranomafana, Madagascar
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Victor R Rabeza
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Hery-Tiana R Razanadrakato
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | | | | | | | - Dana R Thomson
- Social Statistics Department, University of Southampton, Southampton, UK
| | - Sidney Atwood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael L Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Josea Ratsirarson
- Ministère de la Sante Publique de Madagascar, Antananarivo, Madagascar
| | | | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- PIVOT, Ranomafana, Madagascar
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39
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Thomson DR, Amoroso C, Atwood S, Bonds MH, Rwabukwisi FC, Drobac P, Finnegan KE, Farmer DB, Farmer PE, Habinshuti A, Hirschhorn LR, Manzi A, Niyigena P, Rich ML, Stulac S, Murray MB, Binagwaho A. Impact of a health system strengthening intervention on maternal and child health outputs and outcomes in rural Rwanda 2005-2010. BMJ Glob Health 2018; 3:e000674. [PMID: 29662695 PMCID: PMC5898359 DOI: 10.1136/bmjgh-2017-000674] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 12/07/2017] [Revised: 03/08/2018] [Accepted: 03/11/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Although Rwanda’s health system underwent major reforms and improvements after the 1994 Genocide, the health system and population health in the southeast lagged behind other areas. In 2005, Partners In Health and the Rwandan Ministry of Health began a health system strengthening intervention in this region. We evaluate potential impacts of the intervention on maternal and child health indicators. Methods Combining results from the 2005 and 2010 Demographic and Health Surveys with those from a supplemental 2010 survey, we compared changes in health system output indicators and population health outcomes between 2005 and 2010 as reported by women living in the intervention area with those reported by the pooled population of women from all other rural areas of the country, controlling for potential confounding by economic and demographic variables. Results Overall health system coverage improved similarly in the comparison groups between 2005 and 2010, with an indicator of composite coverage of child health interventions increasing from 57.9% to 75.0% in the intervention area and from 58.7% to 73.8% in the other rural areas. Under-five mortality declined by an annual rate of 12.8% in the intervention area, from 229.8 to 83.2 deaths per 1000 live births, and by 8.9% in other rural areas, from 157.7 to 75.8 deaths per 1000 live births. Improvements were most marked among the poorest households. Conclusion We observed dramatic improvements in population health outcomes including under-five mortality between 2005 and 2010 in rural Rwanda generally and in the intervention area specifically.
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Affiliation(s)
- Dana R Thomson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Woods Institute, Stanford University, Stanford, California, USA
| | | | - Peter Drobac
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Global Health Delivery, University of Global Health Equity, Kigali, Rwanda
| | - Karen E Finnegan
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Paul E Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Anatole Manzi
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | - Michael L Rich
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sara Stulac
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Agnes Binagwaho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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Bonds MH, Ouenzar MA, Garchitorena A, Cordier LF, McCarty MG, Rich ML, Andriamihaja B, Haruna J, Farmer PE. Madagascar can build stronger health systems to fight plague and prevent the next epidemic. PLoS Negl Trop Dis 2018; 12:e0006131. [PMID: 29300731 PMCID: PMC5754047 DOI: 10.1371/journal.pntd.0006131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- PIVOT Works, Inc., Boston, Massachusetts, United States of America
- * E-mail:
| | | | - Andres Garchitorena
- PIVOT Works, Inc., Boston, Massachusetts, United States of America
- UMR 224 MIVEGEC, Institut de Recherche pour le Développement, Montpellier, France
| | - Laura F. Cordier
- PIVOT Works, Inc., Boston, Massachusetts, United States of America
| | - Meg G. McCarty
- PIVOT Works, Inc., Boston, Massachusetts, United States of America
| | - Michael L. Rich
- PIVOT Works, Inc., Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Benjamin Andriamihaja
- PIVOT Works, Inc., Boston, Massachusetts, United States of America
- Madagascar Institute for the Conservation of Tropical Environments, Antananarivo, Madagascar
| | - Justin Haruna
- PIVOT Works, Inc., Boston, Massachusetts, United States of America
| | - Paul E. Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Garchitorena A, Sokolow SH, Roche B, Ngonghala CN, Jocque M, Lund A, Barry M, Mordecai EA, Daily GC, Jones JH, Andrews JR, Bendavid E, Luby SP, LaBeaud AD, Seetah K, Guégan JF, Bonds MH, De Leo GA. Disease ecology, health and the environment: a framework to account for ecological and socio-economic drivers in the control of neglected tropical diseases. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160128. [PMID: 28438917 PMCID: PMC5413876 DOI: 10.1098/rstb.2016.0128] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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] [Accepted: 01/03/2017] [Indexed: 01/27/2023] Open
Abstract
Reducing the burden of neglected tropical diseases (NTDs) is one of the key strategic targets advanced by the Sustainable Development Goals. Despite the unprecedented effort deployed for NTD elimination in the past decade, their control, mainly through drug administration, remains particularly challenging: persistent poverty and repeated exposure to pathogens embedded in the environment limit the efficacy of strategies focused exclusively on human treatment or medical care. Here, we present a simple modelling framework to illustrate the relative role of ecological and socio-economic drivers of environmentally transmitted parasites and pathogens. Through the analysis of system dynamics, we show that periodic drug treatments that lead to the elimination of directly transmitted diseases may fail to do so in the case of human pathogens with an environmental reservoir. Control of environmentally transmitted diseases can be more effective when human treatment is complemented with interventions targeting the environmental reservoir of the pathogen. We present mechanisms through which the environment can influence the dynamics of poverty via disease feedbacks. For illustration, we present the case studies of Buruli ulcer and schistosomiasis, two devastating waterborne NTDs for which control is particularly challenging.This article is part of the themed issue 'Conservation, biodiversity and infectious disease: scientific evidence and policy implications'.
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Affiliation(s)
- A Garchitorena
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
- PIVOT, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - S H Sokolow
- Department of Biology, Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, USA
| | - B Roche
- UMI UMMISCO 209 IRD/UPMC - Bondy, France
- UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier, Montpellier, France
| | - C N Ngonghala
- Department of Mathematics, University of Florida, Gainesville, FL 32611, USA
| | - M Jocque
- Department of Biology, Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, USA
| | - A Lund
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA 94305, USA
| | - M Barry
- Center for Innovation in Global Health, Stanford University, Stanford, CA 94305, USA
| | - E A Mordecai
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - G C Daily
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - J H Jones
- Department of Earth System Science, Stanford University, Stanford, CA 94305, USA
- Department of Life Sciences, Imperial College, London, UK
| | - J R Andrews
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - E Bendavid
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - S P Luby
- Center for Innovation in Global Health, Stanford University, Stanford, CA 94305, USA
| | - A D LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University, Stanford, CA 94305, USA
| | - K Seetah
- Department of Anthropology, Stanford University, Stanford, CA 94305, USA
| | - J F Guégan
- UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier, Montpellier, France
- Future Earth international programme, OneHealth core research programme, Montréal, Canada
| | - M H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
- PIVOT, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA 02115, USA
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - G A De Leo
- Department of Biology, Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, USA
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Odone A, Calderon R, Becerra MC, Zhang Z, Contreras CC, Yataco R, Galea J, Lecca L, Bonds MH, Mitnick CD, Murray MB. Acquired and Transmitted Multidrug Resistant Tuberculosis: The Role of Social Determinants. PLoS One 2016; 11:e0146642. [PMID: 26765328 PMCID: PMC4713093 DOI: 10.1371/journal.pone.0146642] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 09/07/2015] [Accepted: 12/20/2015] [Indexed: 11/18/2022] Open
Abstract
Although risk factors for multi-drug resistant tuberculosis are known, few studies have differentiated between acquired and transmitted resistance. It is important to identify factors associated with these different mechanisms to optimize control measures. We conducted a prospective cohort study of index TB patients and their household contacts in Lima, Peru to identify risk factors associated with acquired and transmitted resistance, respectively. Patients with higher socioeconomic status (SES) had a 3-fold increased risk of transmitted resistance compared to those with lower SES when acquired resistance served as the baseline. Quality of housing mediated most of the impact of SES.
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Affiliation(s)
- Anna Odone
- Unit of Public Health, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Roger Calderon
- Partners In Health / Socios En Salud, Boston, Massachusetts, United States of America and Lima, Peru
| | - Mercedes C. Becerra
- Partners In Health / Socios En Salud, Boston, Massachusetts, United States of America and Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Zibiao Zhang
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Carmen C. Contreras
- Partners In Health / Socios En Salud, Boston, Massachusetts, United States of America and Lima, Peru
| | - Rosa Yataco
- Partners In Health / Socios En Salud, Boston, Massachusetts, United States of America and Lima, Peru
| | - Jerome Galea
- Partners In Health / Socios En Salud, Boston, Massachusetts, United States of America and Lima, Peru
| | - Leonid Lecca
- Partners In Health / Socios En Salud, Boston, Massachusetts, United States of America and Lima, Peru
| | - Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carole D. Mitnick
- Partners In Health / Socios En Salud, Boston, Massachusetts, United States of America and Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Megan B. Murray
- Partners In Health / Socios En Salud, Boston, Massachusetts, United States of America and Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Garchitorena A, Ngonghala CN, Texier G, Landier J, Eyangoh S, Bonds MH, Guégan JF, Roche B. Environmental transmission of Mycobacterium ulcerans drives dynamics of Buruli ulcer in endemic regions of Cameroon. Sci Rep 2015; 5:18055. [PMID: 26658922 PMCID: PMC4676024 DOI: 10.1038/srep18055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 03/09/2015] [Accepted: 11/02/2015] [Indexed: 11/15/2022] Open
Abstract
Buruli Ulcer is a devastating skin disease caused by the pathogen Mycobacterium ulcerans. Emergence and distribution of Buruli ulcer cases is clearly linked to aquatic ecosystems, but the specific route of transmission of M. ulcerans to humans remains unclear. Relying on the most detailed field data in space and time on M. ulcerans and Buruli ulcer available today, we assess the relative contribution of two potential transmission routes--environmental and water bug transmission--to the dynamics of Buruli ulcer in two endemic regions of Cameroon. The temporal dynamics of Buruli ulcer incidence are explained by estimating rates of different routes of transmission in mathematical models. Independently, we also estimate statistical models of the different transmission pathways on the spatial distribution of Buruli ulcer. The results of these two independent approaches are corroborative and suggest that environmental transmission pathways explain the temporal and spatial patterns of Buruli ulcer in our endemic areas better than the water bug transmission.
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Affiliation(s)
- Andrés Garchitorena
- UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier, Montpellier, France
- Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | - Calistus N. Ngonghala
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Gaëtan Texier
- Service d'épidémiologie et de santé publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
- UMR 912 - SESSTIM - INSERM/IRD/Aix-Marseille Université Faculté de Médecine, Marseille, France
| | - Jordi Landier
- Service d'épidémiologie et de santé publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
- Unité d’Epidémiologie de Maladies Emergentes, Institut Pasteur, Paris, France
| | - Sara Eyangoh
- Laboratoire de Mycobactériologie, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Earth System Science, Stanford University, Stanford, CA 94305, USA
| | - Jean-François Guégan
- UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier, Montpellier, France
- Ecole des Hautes Etudes en Santé Publique, Rennes, France
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Binagwaho A, Farmer PE, Nsanzimana S, Karema C, Gasana M, de Dieu Ngirabega J, Ngabo F, Wagner CM, Nutt CT, Nyatanyi T, Gatera M, Kayiteshonga Y, Mugeni C, Mugwaneza P, Shema J, Uwaliraye P, Gaju E, Muhimpundu MA, Dushime T, Senyana F, Mazarati JB, Gaju CM, Tuyisenge L, Mutabazi V, Kyamanywa P, Rusanganwa V, Nyemazi JP, Umutoni A, Kankindi I, Ntizimira C, Ruton H, Mugume N, Nkunda D, Ndenga E, Mubiligi JM, Kakoma JB, Karita E, Sekabaraga C, Rusingiza E, Rich ML, Mukherjee JS, Rhatigan J, Cancedda C, Bertrand-Farmer D, Bukhman G, Stulac SN, Tapela NM, van der Hoof Holstein C, Shulman LN, Habinshuti A, Bonds MH, Wilkes MS, Lu C, Smith-Fawzi MC, Swain JD, Murphy MP, Ricks A, Kerry VB, Bush BP, Siegler RW, Stern CS, Sliney A, Nuthulaganti T, Karangwa I, Pegurri E, Dahl O, Drobac PC. Rwanda 20 years on: investing in life. Lancet 2014; 384:371-5. [PMID: 24703831 PMCID: PMC4151975 DOI: 10.1016/s0140-6736(14)60574-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two decades ago, the genocide against the Tutsis in Rwanda led to the deaths of 1 million people, and the displacement of millions more. Injury and trauma were followed by the effects of a devastated health system and economy. In the years that followed, a new course set by a new government set into motion equity-oriented national policies focusing on social cohesion and people-centred development. Premature mortality rates have fallen precipitously in recent years, and life expectancy has doubled since the mid-1990s. Here we reflect on the lessons learned in rebuilding Rwanda's health sector during the past two decades, as the country now prepares itself to take on new challenges in health-care delivery.
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Affiliation(s)
| | | | | | | | | | | | - Fidele Ngabo
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Cameron T Nutt
- Dartmouth Center for Health Care Delivery Science, Hanover, NH, USA
| | | | | | | | - Cathy Mugeni
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Joseph Shema
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Erick Gaju
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | | | | | | | | | | | | | | | | | | | - Agathe Umutoni
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Ida Kankindi
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Hinda Ruton
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Nathan Mugume
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Denis Nkunda
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | | | | | | | - Claude Sekabaraga
- Quality and Equity HealthCare-Social Health Enterprise, Kigali, Rwanda
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anne Sliney
- Clinton Health Access Initiative, Boston, MA, USA
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Abstract
Understanding why some human populations remain persistently poor remains a significant challenge for both the social and natural sciences. The extremely poor are generally reliant on their immediate natural resource base for subsistence and suffer high rates of mortality due to parasitic and infectious diseases. Economists have developed a range of models to explain persistent poverty, often characterized as poverty traps, but these rarely account for complex biophysical processes. In this Essay, we argue that by coupling insights from ecology and economics, we can begin to model and understand the complex dynamics that underlie the generation and maintenance of poverty traps, which can then be used to inform analyses and possible intervention policies. To illustrate the utility of this approach, we present a simple coupled model of infectious diseases and economic growth, where poverty traps emerge from nonlinear relationships determined by the number of pathogens in the system. These nonlinearities are comparable to those often incorporated into poverty trap models in the economics literature, but, importantly, here the mechanism is anchored in core ecological principles. Coupled models of this sort could be usefully developed in many economically important biophysical systems--such as agriculture, fisheries, nutrition, and land use change--to serve as foundations for deeper explorations of how fundamental ecological processes influence structural poverty and economic development.
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Affiliation(s)
- Calistus N. Ngonghala
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- National Institute for Mathematical and Biological Synthesis (NIMBioS), The University of Tennessee, Knoxville, Tennessee, United States of America
| | - Mateusz M. Pluciński
- Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, California, United States of America
| | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Paul E. Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Christopher B. Barrett
- Dyson School of Applied Economics and Management and Department of Economics, Cornell University, Ithaca, New York, United States of America
| | - Donald C. Keenan
- Université de Cergy-Pontoise et Théorie Economique, Modélisation, Application (THEMA), Cergy-Pontoise, France
| | - Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- PIVOT, Boston, Massachusetts, United States of America
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Golden CD, Bonds MH, Brashares JS, Rasolofoniaina BJR, Kremen C. Economic valuation of subsistence harvest of wildlife in Madagascar. Conserv Biol 2014; 28:234-243. [PMID: 24405165 PMCID: PMC4151980 DOI: 10.1111/cobi.12174] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/27/2013] [Indexed: 06/02/2023]
Abstract
Wildlife consumption can be viewed as an ecosystem provisioning service (the production of a material good through ecological functioning) because of wildlife's ability to persist under sustainable levels of harvest. We used the case of wildlife harvest and consumption in northeastern Madagascar to identify the distribution of these services to local households and communities to further our understanding of local reliance on natural resources. We inferred these benefits from demand curves built with data on wildlife sales transactions. On average, the value of wildlife provisioning represented 57% of annual household cash income in local communities from the Makira Natural Park and Masoala National Park, and harvested areas produced an economic return of U.S.$0.42 ha(-1) · year(-1). Variability in value of harvested wildlife was high among communities and households with an approximate 2 orders of magnitude difference in the proportional value of wildlife to household income. The imputed price of harvested wildlife and its consumption were strongly associated (p< 0.001), and increases in price led to reduced harvest for consumption. Heightened monitoring and enforcement of hunting could increase the costs of harvesting and thus elevate the price and reduce consumption of wildlife. Increased enforcement would therefore be beneficial to biodiversity conservation but could limit local people's food supply. Specifically, our results provide an estimate of the cost of offsetting economic losses to local populations from the enforcement of conservation policies. By explicitly estimating the welfare effects of consumed wildlife, our results may inform targeted interventions by public health and development specialists as they allocate sparse funds to support regions, households, or individuals most vulnerable to changes in access to wildlife.
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Affiliation(s)
- Christopher D Golden
- Department of Environmental Science, University of California, Berkeley, Policy and Management, 130 Mulford Hall #3114 Berkeley, CA, 94720, U.S.A.; MAHERY (Madagascar Health and Environmental Research), Lot Z1-056 Ankiakandrefana, Maroantsetra, 512, Madagascar.
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Pluciński MM, Ngonghala CN, Getz WM, Bonds MH. Clusters of poverty and disease emerge from feedbacks on an epidemiological network. J R Soc Interface 2013; 10:20120656. [PMID: 23256187 PMCID: PMC3565726 DOI: 10.1098/rsif.2012.0656] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 08/14/2012] [Accepted: 11/28/2012] [Indexed: 11/12/2022] Open
Abstract
The distribution of health conditions is characterized by extreme inequality. These disparities have been alternately attributed to disease ecology and the economics of poverty. Here, we provide a novel framework that integrates epidemiological and economic growth theory on an individual-based hierarchically structured network. Our model indicates that, under certain parameter regimes, feedbacks between disease ecology and economics create clusters of low income and high disease that can stably persist in populations that become otherwise predominantly rich and free of disease. Surprisingly, unlike traditional poverty trap models, these localized disease-driven poverty traps can arise despite homogeneity of parameters and evenly distributed initial economic conditions.
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Affiliation(s)
- Mateusz M Pluciński
- Department of Environmental Science, Policy and Management, University of California, Berkeley, CA 94720, USA.
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48
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Abstract
Vector-borne and parasitic diseases are drivers of the latitudinal gradient in income, and the burden of these diseases is predicted to rise as biodiversity falls. While most of the world is thought to be on long-term economic growth paths, more than one-sixth of the world is roughly as poor today as their ancestors were hundreds of years ago. The majority of the extremely poor live in the tropics. The latitudinal gradient in income is highly suggestive of underlying biophysical drivers, of which disease conditions are an especially salient example. However, conclusions have been confounded by the simultaneous causality between income and disease, in addition to potentially spurious relationships. We use a simultaneous equations model to estimate the relative effects of vector-borne and parasitic diseases (VBPDs) and income on each other, controlling for other factors. Our statistical model indicates that VBPDs have systematically affected economic development, evident in contemporary levels of per capita income. The burden of VBDPs is, in turn, determined by underlying ecological conditions. In particular, the model predicts it to rise as biodiversity falls. Through these positive effects on human health, the model thus identifies measurable economic benefits of biodiversity. While most of the world is thought to be growing economically, more than one-sixth of the world is roughly as poor today as their ancestors were hundreds of years ago. The extremely poor live largely in the tropics. This latitudinal gradient in income suggests that there are biophysical factors, such as the burden of disease, driving the effect. However, measuring the effects of disease on broad economic indicators is confounded by the fact that economic indicators simultaneously influence health. We get around this by using simultaneous equation modeling to estimate the relative effects of disease and income on each other while controlling for other factors. Our model indicates that vector-borne and parasitic diseases (VBPDs) have systematically affected economic development. Importantly, we show that the burden of VBPDs is, in turn, determined by underlying ecological conditions. In particular, the model predicts that the burden of disease will rise as biodiversity falls. The health benefits of biodiversity, therefore, potentially constitute an ecosystem service that can be quantified in terms of income generated.
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Affiliation(s)
- Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
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Dhillon RS, Bonds MH, Fraden M, Ndahiro D, Ruxin J. The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda. Glob Public Health 2011; 7:71-86. [PMID: 21732708 DOI: 10.1080/17441692.2011.593536] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five 'imidugudu' or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immediately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights.
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50
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Plucinski MM, Ngonghala CN, Bonds MH. Health safety nets can break cycles of poverty and disease: a stochastic ecological model. J R Soc Interface 2011; 8:1796-803. [PMID: 21593026 DOI: 10.1098/rsif.2011.0153] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The persistence of extreme poverty is increasingly attributed to dynamic interactions between biophysical processes and economics, though there remains a dearth of integrated theoretical frameworks that can inform policy. Here, we present a stochastic model of disease-driven poverty traps. Whereas deterministic models can result in poverty traps that can only be broken by substantial external changes to the initial conditions, in the stochastic model there is always some probability that a population will leave or enter a poverty trap. We show that a 'safety net', defined as an externally enforced minimum level of health or economic conditions, can guarantee ultimate escape from a poverty trap, even if the safety net is set within the basin of attraction of the poverty trap, and even if the safety net is only in the form of a public health measure. Whereas the deterministic model implies that small improvements in initial conditions near the poverty-trap equilibrium are futile, the stochastic model suggests that the impact of changes in the location of the safety net on the rate of development may be strongest near the poverty-trap equilibrium.
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Affiliation(s)
- Mateusz M Plucinski
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720, USA
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