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Zoerhoff KL, Mbabazi PS, Gass K, Kraemer J, Fuller BB, Blair L, Bougma R, Meite A, Negussu N, Gashaw B, Nash SD, Biritwum NK, Lemoine JF, Ullyartha Pangaribuan H, Wijayanti E, Kollie K, Rasoamanamihaja CF, Juziwelo L, Mkwanda S, Rimal P, Gnandou I, Diop B, Dorkenoo AM, Bronzan R, Tukahebwa EM, Kabole F, Yevstigneyeva V, Bisanzio D, Courtney L, Koroma J, Endayishimye E, Reithinger R, Baker MC, Fleming FM. How well do coverage surveys and programmatically reported mass drug administration coverage match? Results from 214 mass drug administration campaigns in 15 countries, 2008-2017. BMJ Glob Health 2023; 8:e011193. [PMID: 37142297 PMCID: PMC10163531 DOI: 10.1136/bmjgh-2022-011193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/18/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Delivering preventive chemotherapy through mass drug administration (MDA) is a central approach in controlling or eliminating several neglected tropical diseases (NTDs). Treatment coverage, a primary indicator of MDA performance, can be measured through routinely reported programmatic data or population-based coverage evaluation surveys. Reported coverage is often the easiest and least expensive way to estimate coverage; however, it is prone to inaccuracies due to errors in data compilation and imprecise denominators, and in some cases measures treatments offered as opposed to treatments swallowed. OBJECTIVE Analyses presented here aimed to understand (1) how often coverage calculated using routinely reported data and survey data would lead programme managers to make the same programmatic decisions; (2) the magnitude and direction of the difference between these two estimates, and (3) whether there is meaningful variation by region, age group or country. METHODS We analysed and compared reported and surveyed treatment coverage data from 214 MDAs implemented between 2008 and 2017 in 15 countries in Africa, Asia and the Caribbean. Routinely reported treatment coverage was compiled using data reported by national NTD programmes to donors, either directly or via NTD implementing partners, following the implementation of a district-level MDA campaign; coverage was calculated by dividing the number of individuals treated by a population value, which is typically based on national census projections and occasionally community registers. Surveyed treatment coverage came from post-MDA community-based coverage evaluation surveys, which were conducted as per standardised WHO recommended methodology. RESULTS Coverage estimates using routine reporting and surveys gave the same result in terms of whether the minimum coverage threshold was reached in 72% of the MDAs surveyed in the Africa region and in 52% in the Asia region. The reported coverage value was within ±10 percentage points of the surveyed coverage value in 58/124 of the surveyed MDAs in the Africa region and 19/77 in the Asia region. Concordance between routinely reported and surveyed coverage estimates was 64% for the total population and 72% for school-age children. The study data showed variation across countries in the number of surveys conducted as well as the frequency with which there was concordance between the two coverage estimates. CONCLUSIONS Programme managers must grapple with making decisions based on imperfect information, balancing needs for accuracy with cost and available capacity. The study shows that for many of the MDAs surveyed, based on the concordance with respect to reaching the minimum coverage thresholds, the routinely reported data were accurate enough to make programmatic decisions. Where coverage surveys do show a need to improve accuracy of routinely reported results, NTD programme managers should use various tools and approaches to strengthen data quality in order to use data for decision-making to achieve NTD control and elimination goals.
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Affiliation(s)
- Kathryn L Zoerhoff
- International Development Group, RTI International, Washington, District of Columbia, USA
- The Task Force for Global Health, Decatur, Georgia, USA
| | | | | | - John Kraemer
- School of Health, Georgetown University, Washington, District of Columbia, USA
| | - Brian B Fuller
- International Development Group, RTI International, Washington, District of Columbia, USA
- Helen Keller International, New York, New York, USA
| | | | - Roland Bougma
- Ministère de la Santé et de l'Hygiène Publique, Ouagadougou, Burkina Faso
| | - Aboulaye Meite
- Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Nebiyu Negussu
- Federal Ministry of Health, Addis Ababa, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | | | | | - Pradip Rimal
- Ministry of Health and Population, Kathmandu, Nepal
| | - Issa Gnandou
- Ministère de la Santé Publique, de la Population, et des Affaires Sociales, Niamey, Niger
| | - Bocar Diop
- Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Ameyo Monique Dorkenoo
- Ministère de la Santé, de l'Hygiène Publique, et de l'Accès Universel aux Soins, Lomé, Togo
| | | | | | - Fatima Kabole
- Zanzibar Ministry of Health, Stone Town, Tanzania, United Republic of
| | | | - Donal Bisanzio
- International Development Group, RTI International, Washington, District of Columbia, USA
| | - Lauren Courtney
- International Development Group, RTI International, Washington, District of Columbia, USA
| | | | | | - Richard Reithinger
- International Development Group, RTI International, Washington, District of Columbia, USA
| | - Margaret C Baker
- International Development Group, RTI International, Washington, District of Columbia, USA
- School of Health, Georgetown University, Washington, District of Columbia, USA
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Fuller BB, Harris V, Parker C, Martinez A, Toubali E, Ebene BC, Asemanyi-Mensah K, Dembele M, Salissou AB, Kabré C, Meite A, Kane NM, Kargbo-Labour I, Batcho W, Diaby A, Yevstigneyeva V, Stukel DM. Contextual determinants of mass drug administration performance: Modelling fourteen years of lymphatic filariasis treatments in West Africa. PLoS Negl Trop Dis 2023; 17:e0011146. [PMID: 36827450 PMCID: PMC9994721 DOI: 10.1371/journal.pntd.0011146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 03/08/2023] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Effective mass drug administration (MDA) is the cornerstone in the elimination of lymphatic filariasis (LF) and a critical component in combatting all neglected tropical diseases for which preventative chemotherapy is recommended (PC-NTDs). Despite its importance, MDA coverage, however defined, is rarely investigated systematically across time and geography. Most commonly, investigations into coverage react to unsatisfactory outcomes and tend to focus on a single year and health district. Such investigations omit more macro-level influences including sociological, environmental, and programmatic factors. The USAID NTD database contains measures of performance from thousands of district-level LF MDA campaigns across 14 years and 10 West African countries. Specifically, performance was measured as an MDA's epidemiological coverage, calculated as persons treated divided by persons at risk. This analysis aims to explain MDA coverage across time and geography in West Africa using sociological, environmental, and programmatic factors. METHODOLOGY The analysis links epidemiological coverage data from 3,880 LF MDAs with contextual, non-NTD data via location (each MDA was specific to a health district) and time (MDA month, year). Contextual data included rainfall, temperature, violence or social unrest, COVID-19, the 2014 Ebola outbreak, road access/isolation, population density, observance of Ramadan, and the number of previously completed MDAs. PRINCIPAL FINDINGS We fit a hierarchical linear regression model with coverage as the dependent variable and performed sensitivity analyses to confirm the selection of the explanatory factors. Above average rainfall, COVID-19, Ebola, violence and social unrest were all significantly associated with lower coverage. Years of prior experience in a district and above average temperature were significantly associated with higher coverage. CONCLUSIONS/SIGNIFICANCE These generalized and context-focused findings supplement current literature on coverage dynamics and MDA performance. Findings may be used to quantify typically anecdotal considerations in MDA planning. The model and methodology are offered as a tool for further investigation.
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Affiliation(s)
- Brian B. Fuller
- Helen Keller International, Washington, District of Columbia, United States of America
- * E-mail:
| | - Vance Harris
- FHI 360, Denver, Colorado, United States of America
| | - Caleb Parker
- FHI 360, Durham, North Carolina, United States of America
| | | | - Emily Toubali
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, District of Columbia, United States of America
| | - Blandine Clarisse Ebene
- National Programme for Onchocerciasis and Lymphatic Filariasis Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Kofi Asemanyi-Mensah
- Neglected Tropical Diseases Programme, Disease Control and Prevention Department, Ghana Health Service, Public Health Division, Accra, Ghana
| | - Massitan Dembele
- National Programme for the Elimination of LF, Ministry of Health, Bamako, Mali
| | | | - Cathérine Kabré
- Programme national de lutte contre les maladies tropicales négligées, Ministry of Health, Ouagadougou, Burkina Faso
| | - Aboulaye Meite
- Programme national de lutte contre les maladies tropicales négligées à chimiothérapie préventive, Ministry of Health, Abidjan, Côte d’Ivoire
| | - Ndeye Mbacke Kane
- National Neglected Tropical Diseases Control Program, Ministry of Health, Dakar, Senegal
| | - Ibrahim Kargbo-Labour
- Neglected Tropical Disease Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministry of Health, Cotonou, Benin
| | - Aissatou Diaby
- National Neglected Tropical Diseases Control Program, Ministry of Health, Conakry, Guinea
| | - Violetta Yevstigneyeva
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, District of Columbia, United States of America
| | - Diana Maria Stukel
- Act to End NTDs | West, FHI 360, Washington, District of Columbia, United States of America
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Wainwright E, Evans D, Rotondo L, Pou B, Yevstigneyeva V, Zoerhoff KL, Ottesen EA, Reithinger R. The Elimination of Neglected Tropical Diseases: A Case Study Exemplifying How Foreign Assistance Funding Can Be Catalytic in Reducing the Burden of Major Global Health Conditions. Clin Infect Dis 2021; 70:958-964. [PMID: 31402376 DOI: 10.1093/cid/ciz742] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/01/2019] [Indexed: 11/13/2022] Open
Abstract
In 2006, following direct advocacy and published rationale, the US Agency for International Development (USAID) established a neglected tropical diseases (NTDs) program to support the scale-up of integrated platforms to target the elimination and control of 5 NTDs-lymphatic filariasis, trachoma, onchocerciasis, schistosomiasis, and soil-transmitted helminthiasis. By 2017, more than 2.3 billion NTD treatments had been delivered to at-risk populations in 25 countries, leveraging $19 billion in donated drugs-approximately $26 dollars in donated medicine per $1 spent by USAID. As a result, most of the supported countries are on track to achieve their elimination goals (for lymphatic filariasis and trachoma) by 2020 or 2021 and their control goals soon thereafter. Though "small" when compared to other global health initiatives, this investment proved to be catalytic, and indeed highlights how foreign assistance funding can be transformative, in reducing the burden of major global health conditions such as NTDs.
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Affiliation(s)
| | - Darin Evans
- US Agency for International Development, Washington, DC, USA
| | | | | | | | | | - Eric A Ottesen
- RTI International, Washington, DC, USA.,Task Force for Global Health, Decatur, Georgia, USA
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Burgert-Brucker CR, Zoerhoff KL, Headland M, Shoemaker EA, Stelmach R, Karim MJ, Batcho W, Bougouma C, Bougma R, Benjamin Didier B, Georges N, Marfo B, Lemoine JF, Pangaribuan HU, Wijayanti E, Coulibaly YI, Doumbia SS, Rimal P, Salissou AB, Bah Y, Mwingira U, Nshala A, Muheki E, Shott J, Yevstigneyeva V, Ndayishimye E, Baker M, Kraemer J, Brady M. Risk factors associated with failing pre-transmission assessment surveys (pre-TAS) in lymphatic filariasis elimination programs: Results of a multi-country analysis. PLoS Negl Trop Dis 2020; 14:e0008301. [PMID: 32479495 PMCID: PMC7289444 DOI: 10.1371/journal.pntd.0008301] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/08/2019] [Revised: 06/11/2020] [Accepted: 04/16/2020] [Indexed: 11/20/2022] Open
Abstract
Achieving elimination of lymphatic filariasis (LF) as a public health problem requires a minimum of five effective rounds of mass drug administration (MDA) and demonstrating low prevalence in subsequent assessments. The first assessments recommended by the World Health Organization (WHO) are sentinel and spot-check sites—referred to as pre-transmission assessment surveys (pre-TAS)—in each implementation unit after MDA. If pre-TAS shows that prevalence in each site has been lowered to less than 1% microfilaremia or less than 2% antigenemia, the implementation unit conducts a TAS to determine whether MDA can be stopped. Failure to pass pre-TAS means that further rounds of MDA are required. This study aims to understand factors influencing pre-TAS results using existing programmatic data from 554 implementation units, of which 74 (13%) failed, in 13 countries. Secondary data analysis was completed using existing data from Bangladesh, Benin, Burkina Faso, Cameroon, Ghana, Haiti, Indonesia, Mali, Nepal, Niger, Sierra Leone, Tanzania, and Uganda. Additional covariate data were obtained from spatial raster data sets. Bivariate analysis and multilinear regression were performed to establish potential relationships between variables and the pre-TAS result. Higher baseline prevalence and lower elevation were significant in the regression model. Variables statistically significantly associated with failure (p-value ≤0.05) in the bivariate analyses included baseline prevalence at or above 5% or 10%, use of Filariasis Test Strips (FTS), primary vector of Culex, treatment with diethylcarbamazine-albendazole, higher elevation, higher population density, higher enhanced vegetation index (EVI), higher annual rainfall, and 6 or more rounds of MDA. This paper reports for the first time factors associated with pre-TAS results from a multi-country analysis. This information can help countries more effectively forecast program activities, such as the potential need for more rounds of MDA, and prioritize resources to ensure adequate coverage of all persons in areas at highest risk of failing pre-TAS. Achieving elimination of lymphatic filariasis (LF) as a public health problem requires a minimum of five rounds of mass drug administration (MDA) and being able to demonstrate low prevalence in several subsequent assessments. LF elimination programs implement sentinel and spot-check site assessments, called pre-TAS, to determine whether districts are eligible to implement more rigorous population-based surveys to determine whether MDA can be stopped or if further rounds are required. Reasons for failing pre-TAS are not well understood and have not previously been examined with data compiled from multiple countries. For this analysis, we analyzed data from routine USAID and WHO reports from Bangladesh, Benin, Burkina Faso, Cameroon, Ghana, Haiti, Indonesia, Mali, Nepal, Niger, Sierra Leone, Tanzania, and Uganda. In a model that included multiple variables, high baseline prevalence and lower elevation were significant. In models comparing only one variable to the outcome, the following were statistically significantly associated with failure: higher baseline prevalence at or above 5% or 10%, use of the FTS, primary vector of Culex, treatment with diethylcarbamazine-albendazole, lower elevation, higher population density, higher Enhanced Vegetation Index, higher annual rainfall, and six or more rounds of mass drug administration. These results can help national programs plan MDA more effectively, e.g., by focusing resources on areas with higher baseline prevalence and/or lower elevation.
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Affiliation(s)
| | - Kathryn L. Zoerhoff
- Global Health Division, RTI International, Washington, DC, United States of America
| | - Maureen Headland
- Global Health Division, RTI International, Washington, DC, United States of America
- Global Health, Population, and Nutrition, FHI 360, Washington, DC, United States of America
| | - Erica A. Shoemaker
- Global Health Division, RTI International, Washington, DC, United States of America
| | - Rachel Stelmach
- Global Health Division, RTI International, Washington, DC, United States of America
| | | | - Wilfrid Batcho
- National Control Program of Communicable Diseases, Ministry of Health, Cotonou, Benin
| | - Clarisse Bougouma
- Lymphatic Filariasis Elimination Program, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Roland Bougma
- Lymphatic Filariasis Elimination Program, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Biholong Benjamin Didier
- National Onchocerciasis and Lymphatic Filariasis Control Program, Ministry of Health, Yaounde, Cameroon
| | - Nko'Ayissi Georges
- National Onchocerciasis and Lymphatic Filariasis Control Program, Ministry of Health, Yaounde, Cameroon
| | - Benjamin Marfo
- Neglected Tropical Diseases Programme, Ghana Health Service, Accra, Ghana
| | | | | | - Eksi Wijayanti
- National Institute Health Research & Development, Ministry of Health, Jakarta, Indonesia
| | - Yaya Ibrahim Coulibaly
- Filariasis Unit, International Center of Excellence in Research, Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Salif Seriba Doumbia
- Filariasis Unit, International Center of Excellence in Research, Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Pradip Rimal
- Epidemiology and Disease Control Division, Department of Health Service, Kathmandu, Nepal
| | | | - Yukaba Bah
- National Neglected Tropical Disease Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Upendo Mwingira
- Neglected Tropical Disease Control Programme, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Andreas Nshala
- IMA World Health/Tanzania NTD Control Programme, Uppsala University, & TIBA Fellow, Dar es Salaam, Tanzania
| | - Edridah Muheki
- Programme to Eliminate Lymphatic Filariasis, Ministry of Health, Kampala, Uganda
| | - Joseph Shott
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, DC, United States of America
| | - Violetta Yevstigneyeva
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, DC, United States of America
| | - Egide Ndayishimye
- Global Health, Population, and Nutrition, FHI 360, Washington, DC, United States of America
| | - Margaret Baker
- Global Health Division, RTI International, Washington, DC, United States of America
| | - John Kraemer
- Global Health Division, RTI International, Washington, DC, United States of America
- Georgetown University, Washington, DC, United States of America
| | - Molly Brady
- Global Health Division, RTI International, Washington, DC, United States of America
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Yevstigneyeva V, Camara-Mejia J, Dumonteil E. Analysis of children's perception of triatomine vectors of chagas disease through drawings: opportunities for targeted health education. PLoS Negl Trop Dis 2014; 8:e3217. [PMID: 25275321 PMCID: PMC4183480 DOI: 10.1371/journal.pntd.0003217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 05/15/2014] [Accepted: 08/26/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chagas disease is a tropical parasitic disease affecting about 10 million people, mostly in the Americas, and transmitted mainly by triatomine bugs. Insect vector control with indoor residual insecticides and the promotion of housing improvement is the main control intervention. The success of such interventions relies on their acceptance and appropriation by communities, which depends on their knowledge and perceptions of both the disease and the vector. In this study, we investigated school-aged children's knowledge and perception on triatomine vectors and Chagas disease to further understand how communities view this vector and the disease in Yucatan, Mexico. METHODOLOGY/PRINCIPAL FINDINGS We performed an analysis of children's drawings on the theme of triatomines and their house in several rural villages, to explore in an open-ended manner their views, understanding and misconceptions. A total of 261 drawings were collected from children ages 6-12 from four villages. We found that children are very familiar with triatomine vectors, and know very well many aspects of their biology and ecology, and in particular their blood-feeding habits. On the other hand, their drawings suggest that the role of triatomines as vectors of a chronic and severe cardiac disease is less understood, and the main perceived health threat appears limited to the bite itself, as previously observed in adults. CONCLUSIONS/SIGNIFICANCE These results have important implications for the specific design of future education materials and campaigns, and for the promotion of the inclusion of children in raising Chagas disease awareness in these endemic communities.
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Affiliation(s)
- Violetta Yevstigneyeva
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Javier Camara-Mejia
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | - Eric Dumonteil
- Laboratorio de Parasitología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
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