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Utunen H, Balaciano G, Arabi E, Tokar A, Bhatiasevi A, Noyes J. Learning interventions and training methods in health emergencies: A scoping review. PLoS One 2024; 19:e0290208. [PMID: 39012917 PMCID: PMC11251632 DOI: 10.1371/journal.pone.0290208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/01/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Keeping the health workforce and the public informed about the latest evolving health information during a health emergency is critical to preventing, detecting and responding to infectious disease outbreaks or other health emergencies. Having a well-informed, ready, willing, and skilled workforce and an informed public can help save lives, reduce diseases and suffering, and minimize socio-economic loss in affected communities and countries. Providing "just in time" support and opportunities for learning in health emergencies is much needed for capacity building. In this paper, 'learning intervention' refers to the provision of ad-hoc, focused, or personalized training sessions with the goal of preparing the health workers for emergencies or filling specific knowledge or skill gaps. We refer to 'training methods' as instructional design strategies used to teach someone the necessary knowledge and skills to perform a task. METHODS We conducted a scoping review to map and better understand what learning interventions and training methods have been used in different types of health emergencies and by whom. Studies were identified using six databases (Pubmed/Medline, Embase, Hinari, WorldCat, CABI and Web of Science) and by consulting with experts. Characteristics of studies were mapped and displayed and major topic areas were identified. RESULTS Of the 319 records that were included, contexts most frequently covered were COVID-19, disasters in general, Ebola and wars. Four prominent topic areas were identified: 1) Knowledge acquisition, 2) Emergency plans, 3) Impact of the learning intervention, and 4) Training methods. Much of the evidence was based on observational methods with few trials, which likely reflects the unique context of each health emergency. Evolution of methods was apparent, particularly in virtual learning. Learning during health emergencies appeared to improve knowledge, general management of the situation, quality of life of both trainers and affected population, satisfaction and clinical outcomes. CONCLUSION This is the first scoping review to map the evidence, which serves as a first step in developing urgently needed global guidance to further improve the quality and reach of learning interventions and training methods in this context.
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Affiliation(s)
- Heini Utunen
- Health Emergencies Programme, Learning and Capacity Development Unit, World Health Organization, Genève, Switzerland
| | - Giselle Balaciano
- Health Emergencies Programme, Learning and Capacity Development Unit, World Health Organization, Genève, Switzerland
| | - Elham Arabi
- Health Emergencies Programme, Learning and Capacity Development Unit, World Health Organization, Genève, Switzerland
| | - Anna Tokar
- Health Emergencies Programme, Learning and Capacity Development Unit, World Health Organization, Genève, Switzerland
| | - Aphaluck Bhatiasevi
- Health Emergencies Programme, Learning and Capacity Development Unit, World Health Organization, Genève, Switzerland
| | - Jane Noyes
- Department of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
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Closser S, Neel AH, Gerber S, Alonge O. From legacy to integration in the Global Polio Eradication Initiative: looking back to look forward. BMJ Glob Health 2024; 9:e014758. [PMID: 38770815 PMCID: PMC11085807 DOI: 10.1136/bmjgh-2023-014758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION The Global Polio Eradication Initiative (GPEI) is a global single-disease programme with an extensive infrastructure in some of the world's most underserved areas. It provides a key example of the opportunities and challenges of transition efforts-the process of shifting from donor-funded, single-disease programmes to programmes with more integrated and sustainable programmatic and funding streams. Our goal is to closely analyse the social and political dynamics of the polio transition in the 2010s to provide insights into today, as well as lessons for other programmes. METHODS We conducted semistructured interviews with GPEI officials involved in transition planning across GPEI partner agencies (n=11). We also drew on document review and interviews with national and subnational actors in Nigeria, India, Ethiopia and the Democratic Republic of the Congo. We inductively analysed this material to capture emergent themes in the evolution of transition activities in the GPEI. RESULTS Since the mid-2010s, GPEI actors expressed concern that polio's assets should not be lost when polio was eradicated. Planning for polio's legacy, however, proved complicated. The GPEI's commitment to and focus on eradication had taken precedence over strong collaborations outside the polio programme, making building alliances for transition challenging. There were also complex questions around who should be responsible for the transition process, and which agencies would ultimately pay for and deliver polio-funded functions. Current efforts to achieve 'integration' both have great promise and must grapple with these same issues. DISCUSSION Within the GPEI, relinquishing control to other programmes and planning for significant, long-term funding for transition will be central to achieving successful integration and eventual transition. Beyond polio, other vertical programmes can benefit from going beyond transition 'planning' to integrate transition into the initial design of vertical programmes.
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Affiliation(s)
- Svea Closser
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abigail H Neel
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sue Gerber
- Independent Consultant, Truchas, New Mexico, USA
| | - Olakunle Alonge
- Sparkman Center for Global Health, The University of Alabama, Birmingham, Alabama, USA
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Kisanga A, Stamidis KV, Rumbe S, Lamunu D, Ben A, Thomas GR, Berchmans J. Leveraging the CORE Group Partners Project Polio Infrastructure to Integrate COVID-19 Vaccination and Routine Immunization in South Sudan. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300178. [PMID: 38129123 PMCID: PMC10948123 DOI: 10.9745/ghsp-d-23-00178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Countries with fragile health systems like South Sudan experienced significant impacts on routine immunization during the COVID-19 pandemic. Routine immunization in children aged younger than 1 year declined due to pandemic-related constraints and was compounded by the introduction of the COVID-19 vaccine, which was met with hesitancy and reluctance. When South Sudan reported the first COVID-19 case in March 2020, the CORE Group Partners Project (CGPP) rapidly integrated the COVID-19 outbreak response into its ongoing polio eradication activities, leveraging the existing polio infrastructure and human resources. We describe the integration process, results, and challenges and detail the impact of the integration on coverage for both routine immunization and COVID-19 vaccinations. METHODS Efforts to integrate COVID-19 vaccination and routine immunization service delivery were implemented in 5 phases: assessing the need, developing multisector collaborations, developing a service delivery plan, assessing implementation readiness, and implementing and evaluating the service delivery plan. Integration efforts prioritized coordination, training vaccinators and volunteers, development of microplans, data management, and last-mile vaccine delivery. Integrated service delivery was implemented through "one-stop shop" sessions where communities accessed routine immunizations for children, COVID-19 vaccinations for adults, and other primary health services. RESULTS Integrating health service delivery contributed to improved routine immunization coverage among children, improved COVID-19 vaccination coverage among adults, reduced cost for service delivery, and increased access to more comprehensive health services in hard-to-reach communities. COVID-19 vaccinations were delivered at US$4.70 per dose, a cost substantially lower than other reported delivery mechanisms. CONCLUSION Integration can yield positive results and improve access to vaccination and other health services for communities. However, it requires clear policy guidelines, commitment, and strong collaboration. Challenges included resistance from stakeholders, overstretched human resources, and diversion of funding and attention from program areas, which were overcome through deliberate high-level advocacy, partnership, and intensified community engagement.
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Affiliation(s)
| | | | - Samuel Rumbe
- CORE Group Partners Project South Sudan, Juba, South Sudan
| | - Doris Lamunu
- CORE Group Partners Project South Sudan, Juba, South Sudan
| | - Adil Ben
- CORE Group Partners Project South Sudan, Juba, South Sudan
| | | | - Jean Berchmans
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Zhang T, Rabhi F, Chen X, Paik HY, MacIntyre CR. A machine learning-based universal outbreak risk prediction tool. Comput Biol Med 2024; 169:107876. [PMID: 38176209 DOI: 10.1016/j.compbiomed.2023.107876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
In order to prevent and control the increasing number of serious epidemics, the ability to predict the risk caused by emerging outbreaks is essential. However, most current risk prediction tools, except EPIRISK, are limited by being designed for targeting only one specific disease and one country. Differences between countries and diseases (e.g., different economic conditions, different modes of transmission, etc.) pose challenges for building models with cross-country and cross-disease prediction capabilities. The limitation of universality affects domestic and international efforts to control and prevent pandemic outbreaks. To address this problem, we used outbreak data from 43 diseases in 206 countries to develop a universal risk prediction system that can be used across countries and diseases. This system used five machine learning models (including Neural Network XGBoost, Logistic Boost, Random Forest and Kernel SVM) to predict and vote together to make ensemble predictions. It can make predictions with around 80%-90 % accuracy from economic, cultural, social, and epidemiological factors. Three different datasets were designed to test the performance of ML models under different realistic situations. This prediction system has strong predictive ability, adaptability, and generality. It can give universal outbreak risk assessment that are not limited by border or disease type, facilitate rapid response to pandemic outbreaks, government decision-making and international cooperation.
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Affiliation(s)
- Tianyu Zhang
- FinanceIT Research Group, University of New South Wales, Sydney, NSW, Australia.
| | - Fethi Rabhi
- FinanceIT Research Group, University of New South Wales, Sydney, NSW, Australia
| | - Xin Chen
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Hye-Young Paik
- School of Computer Science and Engineering, Faulty of Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Chandini Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia; College of Public Service & Community Solutions, Arizona State University, Tempe, AZ, 85004, United States
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Mukherjee S, Asthana S, Ukponu W, Ihueze AC, Gobir IB, Phelan AL, Standley CJ. National and subnational governance and decision-making processes during the COVID-19 pandemic in Nigeria: an empirical analysis. BMJ Glob Health 2023; 8:e012965. [PMID: 37696545 PMCID: PMC10496651 DOI: 10.1136/bmjgh-2023-012965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023] Open
Abstract
Governance of the COVID-19 pandemic required decision-makers to make and implement decisions amidst uncertainty, public pressure and time constraints. However, few studies have attempted to assess these decision-making processes empirically during health emergencies. Thus, we aimed to understand governance, defined as the process of decision-making and implementation of decisions, during the COVID-19 pandemic in Nigeria. We conducted key informant interviews and focus group discussions with national and subnational government officials, civil society organisation (CSO) members, development partners and academic experts. Our study identified several themes on governance and decision-making processes. First, Nigeria established high-level decision-making structures at the federal and state levels, providing clear and integrated multisectoral decision-making mechanism. However, due to the emergence of conflicts between government levels, there is a need to strengthen intergovernmental arrangements. Second, while decision-makers relied on input from academic experts and CSOs, additional efforts are required to engage such stakeholders in decision-making processes, especially during the early stages of health emergencies. Third, Nigeria's previous experiences responding to disease outbreaks aided the overall response, as many capacities and coordination mechanisms for cohesive action were present. Fourth, while decision-makers took a holistic view of scientific, social and economic factors for decision-making, this process was also adaptive to account for rapidly evolving information. Lastly, more efforts are needed to ensure decisions are inclusive, equitable and transparent, and improve overall public trust in governance processes. This study provides insights and identifies opportunities to enhance governance and decision-making processes in health emergency responses, aiding future pandemic preparedness efforts.
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Affiliation(s)
- Sanjana Mukherjee
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
| | - Sumegha Asthana
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
| | | | | | - Ibrahim B Gobir
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Alexandra L Phelan
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Health Security, Johns Hopkins University, Baltimore, Maryland, USA
| | - Claire J Standley
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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Braka F, Adamu U, Siddique A, Bolu O, Damisa E, Banda R, Gerald S, Korir C, Usman S, Mohammed A, Aladeshawe S, Tegegne S, Nomhwange T, Waziri E, Nguku P, Erbeto T, Nsubuga P, Shuaib F. The role of polio emergency operations centers: perspectives for future disease control initiatives in Nigeria. Pan Afr Med J 2023; 45:8. [PMID: 38370098 PMCID: PMC10874100 DOI: 10.11604/pamj.supp.2023.45.2.41308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 02/20/2024] Open
Abstract
The Nigeria Polio Emergency Operations Centre (EOC) was established in October 2012 to strengthen coordination, provide strategic direction based on real-time data analysis, and manage all operational aspects of the polio eradication program. The establishment of seven state-level polio EOCs followed. With success achieved in the interruption of wild poliovirus (WPV) transmission as certified in 2020, the future direction of the polio EOC is under consideration. This paper describes the role of the polio EOC in other emergencies and perspectives on future disease control initiatives. A description of the functionality and operations of the polio EOC and a review of documentation of non-polio activities supported by the EOC was done. Key informant insights of national and state-level stakeholders were collected through an electronic questionnaire to determine their perspectives on the polio EOC's contributions and its future role in other public health interventions. The polio EOC structure is based on an incident management system with clear terms of reference and accountability and with full partner coordination. A decline in WPV1 cases was observed from 122 cases in 2012 to 0 in 2015; previously undetected transmission of WPV1 was confirmed in 2016 and all transmission was interrupted under the coordination of the EOCs at national and state levels. During 2014-2019, the polio EOC infrastructure and staff expertise were used to investigate and respond to outbreaks of Ebola, measles, yellow fever, and meningitis and to oversee maternal and neonatal tetanus elimination campaigns. The EOC structure at the national and state levels has contributed to the positive achievements in the polio eradication program in Nigeria and further in the coordination of other disease control and emergency response activities. The transition of the polio EOCs and their capacities to support other non-polio programs will contribute to harnessing the country's capacity for effective coordination of public health initiatives and disease outbreaks.
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Affiliation(s)
- Fiona Braka
- World Health Organization Country Office, Abuja, Nigeria
| | - Usman Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Anis Siddique
- United Nations Children Education Fund, Abuja, Nigeria
| | - Omotayo Bolu
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Eunice Damisa
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Richard Banda
- World Health Organization Country Office, Abuja, Nigeria
| | - Sume Gerald
- World Health Organization Country Office, Abuja, Nigeria
| | - Charles Korir
- World Health Organization Country Office, Abuja, Nigeria
| | | | | | | | - Sisay Tegegne
- World Health Organization Country Office, Abuja, Nigeria
| | | | - Endie Waziri
- Africa Field Epidemiology Network, Abuja, Nigeria
| | | | - Tesfaye Erbeto
- World Health Organization Country Office, Abuja, Nigeria
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta Georgia, United States
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Ihekweazu C. Lessons from Nigeria's Adaptation of Global Health Initiatives during the COVID-19 Pandemic. Emerg Infect Dis 2022; 28:S299-S301. [PMID: 36502443 DOI: 10.3201/eid2813.221175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Nigeria receives funds from several global health initiatives that are aimed at addressing elevated risks and overall burden of infectious disease outbreaks. These funds include the Global Fund to Fight AIDS, Tuberculosis and Malaria; US President's Emergency Plan for AIDS Relief; US President's Malaria Initiative; and Global Polio Eradication Initiative. These initiatives have contributed to a substantial reduction in illness and death from HIV, tuberculosis, malaria, and polio. However, Nigeria has experienced mixed success with leveraging the capacities built through these donor-funded vertical programs to respond to new health threats. This report describes experiences using resources from vertical disease programs by the Nigeria Centre for Disease Control in response to the 2014-2016 Ebola outbreak in West Africa and the COVID-19 pandemic. Integrating resources from different disease programs with government-led systems and institutions will improve responses to endemic outbreaks and preparedness for future pandemics in Nigeria.
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Olateju A, Peters MA, Osaghae I, Alonge O. How service delivery implementation strategies can contribute to attaining universal health coverage: lessons from polio eradication using an implementation science approach. BMC Public Health 2022; 22:1271. [PMID: 35773671 PMCID: PMC9244363 DOI: 10.1186/s12889-022-13681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Improving service delivery is a key strategy for achieving service coverage, one of the two components of universal health coverage (UHC). As one of the largest global public health initiatives, individuals involved with the Global Polio Eradication Initiative (GPEI) have learned many important lessons about service delivery. We identified contributors and challenges to delivering health services at national and subnational levels using experiences from the GPEI. We described strategies used to strengthen service delivery and draw lessons that could be applicable to achieving UHC. Methods Online cross-sectional surveys based on the Consolidated Framework for Implementation Research (CFIR) domains and socioecological model were conducted from 2018–2019. Data were analyzed using an embedded mixed methods approach. Frequencies of the contributors and challenges to service delivery by levels of involvement were estimated. Chi-square tests of independence were used to assess unadjusted associations among categorical outcome variables. Logistic regressions were used to examine the association between respondent characteristics and contributors to successful implementation or implementation challenges. Horizontal analysis of free text responses by CFIR domain was done to contextualize the quantitative results. Results Three thousand nine hundred fifty-five people responded to the online survey which generated 3,659 valid responses. Among these, 887 (24.2%) reported involvement in service delivery at the global, national, or subnational level with more than 90% involved at subnational levels. The main internal contributor of strengthened service delivery was the process of conducting activities (48%); working in frontline role had higher odds of identifying the process of conducting activities as the main internal contributor (AOR: 1.22, p = 0.687). The main external contributor was the social environment (42.5%); having 10–14 years of polio program implementation was significantly associated with identifying the social environment as the main external contributor to strengthened service delivery (AOR: 1.61, p = 0.038). The most frequent implementation challenge was the external environment (56%); working in Eastern Mediterranean region was almost 4 times more likely to identify the external environment as the major challenge in service delivery strengthening (AOR:3.59, p < 0.001). Conclusion Priority actions to improve service delivery include: adopt strategies to systematically reach hard-to-reach populations, expand disease-focused programs to support broader primary healthcare priorities, maximize community outreach strategies to reach broader age groups, build community trust in health workers and develop multisectoral leadership for collaboration. Achieving UHC is contingent on strengthened subnational service delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13681-0.
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Affiliation(s)
- Adetoun Olateju
- Department of International Health, Bloomberg School of Public Health Johns Hopkins University, 615 N Wolfe Street, E8140, Baltimore, MD, 21205, USA
| | - Michael A Peters
- Department of International Health, Bloomberg School of Public Health Johns Hopkins University, 615 N Wolfe Street, E8140, Baltimore, MD, 21205, USA
| | - Ikponmwosa Osaghae
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Olakunle Alonge
- Department of International Health, Bloomberg School of Public Health Johns Hopkins University, 615 N Wolfe Street, E8140, Baltimore, MD, 21205, USA.
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Akinyemi O, Adebayo A, Bassey C, Nwaiwu C, Kalbarczyk A, Nomhwange T, Alonge OO, Owoaje ET. A qualitative exploration of the contributions of Polio Eradication Initiative to the Nigerian health system: policy implications for polio transition planning. Trop Med Health 2022; 50:38. [PMID: 35668515 PMCID: PMC9169377 DOI: 10.1186/s41182-022-00429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nigerian health care system is weak due to lack of coordination, fragmentation of services by donor funding of vertical services, dearth and poor distribution of resources, and inadequate infrastructures. The Global Polio Eradication Initiative has supported the country's health system and provided strategies and skills which need to be documented for use by other health programs attempting disease control or eradication. This study, therefore, explored the contributions of the Polio Eradication Initiative (PEI) activities to the operations of other health programs within the Nigerian health system from the perspectives of frontline workers and managers. METHODS This cross-sectional qualitative study used key informant interviews (KIIs) and inductive thematic analysis. Twenty-nine KIIs were conducted with individuals who have been involved continuously in PEI activities for at least 12 months since the program's inception. This research was part of a more extensive study, the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE), conducted in 2018. The KII tool focused on four major themes: work experience in other health programs, similarities and differences between polio programs and other health programs, contributions of polio programs, and missed opportunities for implementing polio lessons. All interviews were transcribed verbatim and analyzed using a thematic framework. RESULTS The implementation of the PEI has increased health promotion activities and coverage of maternal and child health interventions through the development of tangible and intangible resources, building the capacities of health workers and discovering innovations. The presence of a robust PEI program within a weakened health system of similar programs lacking such extensive support led to a shift in health workers' primary roles. This was perceived to reduce human resources efforts in rural areas with a limited workforce, and to affect other programs' service delivery. CONCLUSION The PEI has made a notable impact on the Nigerian health system. There should be hastened efforts to transition these resources from the PEI into other programs where there are missed opportunities and future control programs. The primary health care managers should continue integration efforts to ensure that programs leverage opportunities within successful programs to improve the health of the community members.
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Affiliation(s)
- Oluwaseun Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Adedamola Adebayo
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christopher Bassey
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chioma Nwaiwu
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Anna Kalbarczyk
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Terna Nomhwange
- Accelerated Disease Control, Immunization, World Health Organization, Abuja, Nigeria
| | | | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Aneja K, Ginsbach K, Gottschalk K, Halabi S, Nardi F. COVID-19 Law Lab: Building Strong Legal Evidence. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:385-389. [PMID: 35894579 DOI: 10.1017/jme.2022.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 Law Lab platform enables quantitative representation of epidemic law and policies in a given country for multiple years, enabling governments and researchers to compare countries, and learn about the impacts and drivers of policy choices. The Law Lab initiative is designed to address the urgent need for quality legal information to support the study of how law and policy can be used to effectively manage this, and future, pandemic(s).
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Affiliation(s)
- Kashish Aneja
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
- SUPREME COURT OF INDIA, NEW DELHI, INDIA
| | - Katherine Ginsbach
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
| | - Katie Gottschalk
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
| | - Sam Halabi
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
- COLORODO SCHOOL OF PUBLIC HEALTH, COLORADO STATE UNIVERSITY, AURORA, COLORADO, USA
| | - Francesca Nardi
- O'NEIL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW, GEORGETOWN UNIVERSITY, WASHINGTON, DC, USA
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Zhang T, Rabhi F, Behnaz A, Chen X, Paik HY, Yao L, MacIntyre CR. Use of automated machine learning for an outbreak risk prediction tool. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Adewole AO, Cash S, Umar A, Ajumobi O, Bala U, Waziri N, Gidado S, Isaac I, Ugbenyo G, Simple E, Nguku P, Saleh A, Yoon S, Kachur SP, Asamoa K. Malaria frontline project: pre-intervention Malaria baseline assessment in Kano and Zamfara States, August 2016. Pan Afr Med J 2021; 40:3. [PMID: 36157563 PMCID: PMC9474827 DOI: 10.11604/pamj.supp.2021.40.1.18809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction In 2016, the Centers for Disease Control and Prevention and the Government of Nigeria initiated the Malaria Frontline Project in Kano and Zamfara States. The project goal is to improve the quality and coverages of malaria interventions adapting polio program strategy. We conducted a baseline assessment of malaria interventions. Methods Twenty-four primary health centers per State were selected using probability sampling. Health workers (HW) were purposively sampled to assess their knowledge of national malaria control guidelines. Clients were selected for exit interview to assess health workers´ adherence to the national guidelines. WHO cluster methodology was used to survey heads of household and women of reproductive age on knowledge of malaria prevention, Long Lasting Insecticidal Net (LLIN) ownership and use. Results Of the 158 HW interviewed, 94.3% knew the correct criteria for malaria diagnosis, 86.1% reported using artemisinin-based therapy to treat uncomplicated malaria. About 45% of HW reported prescribing artemisinin-based combination therapy (ACT) for uncomplicated malaria in first trimester of pregnancy and 39% prescribed quinine. Only 73.9% of fever cases were referred to laboratory as recommended by the national guideline. Households with one LLIN per 2 persons (Kano: 27.1%; Zamfara: 30.0%), LLIN use (Kano: 70.8%; Zamfara: 81.6%) and IPTp1 (Kano: 38.6%; Zamfara: 33.3%). Conclusion most clinicians have knowledge of national guidelines, but fewer adhere to guidelines in practice. Population LLIN ownership, LLIN use among pregnant women and IPTp are lower than the national targets of 58%, 83% and 75% respectively for 2016. We recommend improving health workers´ technical capacity and adherence to national malaria guidelines.
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Affiliation(s)
- Adefisoye Oluwaseun Adewole
- African Field Epidemiology Network, Abuja, Nigeria,,Corresponding author: Adefisoye Oluwaseun Adewole, African Field Epidemiology Network, Abuja, Nigeria.
| | - Shelby Cash
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amina Umar
- African Field Epidemiology Network, Abuja, Nigeria
| | | | - Usaini Bala
- African Field Epidemiology Network, Abuja, Nigeria
| | | | | | - Ieren Isaac
- African Field Epidemiology Network, Abuja, Nigeria
| | | | - Edwin Simple
- African Field Epidemiology Network, Abuja, Nigeria
| | | | - Anisa Saleh
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steve Yoon
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Patrick Kachur
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia,,Mailman School of Public Health, Columbia University, New York, New York
| | - Kwame Asamoa
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Oyebanji O, Ibrahim Abba F, Akande OW, Aniaku EC, Abubakar A, Oladejo J, Aderinola O, Benyeogor E, Owoeye F, Nguku PM, Bemo VN, Ihekweazu C. Building local capacity for emergency coordination: establishment of subnational Public Health Emergency Operations Centres in Nigeria. BMJ Glob Health 2021; 6:bmjgh-2021-007203. [PMID: 34711580 PMCID: PMC8557245 DOI: 10.1136/bmjgh-2021-007203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
Public Health Emergency Operations Centres (PHEOCs) provide a platform for multisectoral coordination and collaboration, to enhance the efficiency of outbreak response activities and enable the control of disease outbreaks. Over the last decade, PHEOCs have been introduced to address the gaps in outbreak response coordination. With its tropical climate, high population density and poor socioeconomic indicators, Nigeria experiences large outbreaks of infectious diseases annually. These outbreaks have led to mortality and negative economic impact as a result of large disparities in healthcare and poor coordination systems. Nigeria is a federal republic with a presidential system of government and a separation of powers among the three tiers of government which are the federal, state and local governments. There are 36 states in Nigeria, and as with other countries with a federal system of governance, each state in Nigeria has its budgets, priorities and constitutional authority for health sector interventions including the response to disease outbreaks. Following the establishment of a National PHEOC in 2017 to improve the coordination of public health emergencies, the Nigeria Centre for Disease Control began the establishment of State PHEOCs. Using a defined process, the establishment of State PHEOCs has led to improved coordination, coherence of thoughts among public health officials, government ownership, commitment and collaboration. This paper aims to share the experience and importance of establishing PHEOCs at national and subnational levels in Nigeria and the lessons learnt which can be used by other countries considering the use of PHEOCs in managing complex emergencies.
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Affiliation(s)
- Oyeronke Oyebanji
- Office of the Director General, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Fatima Ibrahim Abba
- Health Emergency Preparedness and Response, Public Health England, London, UK.,Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Oluwatosin Wuraola Akande
- Prevention, Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Everistus Chijioke Aniaku
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Anwar Abubakar
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - John Oladejo
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Olaolu Aderinola
- Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Emmanuel Benyeogor
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Femi Owoeye
- Independent Consultant, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Patrick M Nguku
- Nigeria Field Epidemiology Training Programme, African Field Epidemiology Network, Abuja, Federal Capital Territory, Nigeria
| | | | - Chikwe Ihekweazu
- Office of the Director General, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
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14
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Mohammed A, Tomori O, Nkengasong JN. Lessons from the elimination of poliomyelitis in Africa. Nat Rev Immunol 2021; 21:823-828. [PMID: 34697501 PMCID: PMC8544186 DOI: 10.1038/s41577-021-00640-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 11/14/2022]
Abstract
In August 2020, Africa was declared free of poliomyelitis (polio), bringing to fruition a goal that took more than 30 years to achieve. This Perspective chronicles global, continental, national and community actions taken by diverse stakeholders that finally led to the elimination of transmission of wild poliovirus in Africa. The cascade of events started with the development of polio vaccines and the realization that polio, much like smallpox, could be eradicated. After a 1988 pledge by the World Health Assembly to eradicate polio globally, concerted and deliberate efforts were made in Africa to achieve this goal. This included the use of evidence-based approaches for the harmonization and standardization of public health strategies, using a network of polio laboratories and emergency operation centres and actively pursuing underserved populations. Innovative solutions to counter challenges such as conflict and vaccine hesitancy may be of use in future public health interventions. This Perspective chronicles the journey to the elimination of transmission of wild poliovirus in Africa, with a critical discussion of the global, continental, national and community actions that were required and the lessons learnt along the way.
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Affiliation(s)
- Abdulaziz Mohammed
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - John N Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
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15
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Rodriguez DC, Neel AH, Mahendradhata Y, Deressa W, Owoaje E, Akinyemi O, Sarker M, Mafuta E, Gupta SD, Salehi AS, Jain A, Alonge O. The effects of polio eradication efforts on health systems: a cross-country analysis using the Develop-Distort Dilemma. Health Policy Plan 2021; 36:707-719. [PMID: 33882118 PMCID: PMC8173659 DOI: 10.1093/heapol/czab044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/12/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Vertical disease control programmes have enormous potential to benefit or weaken health systems, and it is critical to understand how programmes' design and implementation impact the health systems and communities in which they operate. We use the Develop-Distort Dilemma (DDD) framework to understand how the Global Polio Eradication Initiative (GPEI) distorted or developed local health systems. We include document review and 176 interviews with respondents at the global level and across seven focus countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We use DDD domains, contextual factors and transition planning to analyse interactions between the broader context, local health systems and the GPEI to identify changes. Our analysis confirms earlier research including improved health worker, laboratory and surveillance capacity, monitoring and accountability, and efforts to reach vulnerable populations, whereas distortions include shifting attention from routine health services and distorting local payment and incentives structures. New findings highlight how global-level governance structures evolved and affected national actors; issues of country ownership, including for data systems, where the polio programme is not indigenously financed; how expectations of success have affected implementation at programme and community level; and unresolved tensions around transition planning. The decoupling of polio eradication from routine immunization, in particular, plays an outsize role in these issues as it removed attention from system strengthening. In addition to drawing lessons from the GPEI experience for other efforts, we also reflect on the use of the DDD framework for assessing programmes and their system-level impacts. Future eradication efforts should be approached carefully, and new initiatives of any kind should leverage the existing health system while considering equity, inclusion and transition from the start.
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Affiliation(s)
- Daniela C Rodriguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - Abigail H Neel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sekip Utara, Yogyakarta 55281, Indonesia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia
| | - Eme Owoaje
- College of Medicine, University of Ibadan, AddL P.M.B 3017 G.P.O Ibadan, Nigeria
| | - Oluwaseun Akinyemi
- College of Medicine, University of Ibadan, AddL P.M.B 3017 G.P.O Ibadan, Nigeria
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka-1212, Bangladesh.,Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Eric Mafuta
- Kinshasa School of Public Health, University of Kinshasa School of Public Health, Kinshasa, The Democratic Republic of Congo
| | - Shiv D Gupta
- Indian Institute of Health Management Research, 1 Prabhu Dayal Marg, Near Sanganer Airport Terminal 1, Jaipur 302029, India
| | | | - Anika Jain
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
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16
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Haenssgen MJ, Closser S, Alonge O. Impact and effect mechanisms of mass campaigns in resource-constrained health systems: quasi-experimental evidence from polio eradication in Nigeria. BMJ Glob Health 2021; 6:bmjgh-2020-004248. [PMID: 33685940 PMCID: PMC7942242 DOI: 10.1136/bmjgh-2020-004248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/12/2021] [Accepted: 02/10/2021] [Indexed: 12/04/2022] Open
Abstract
Background Mass campaigns are a key strategy for delivering life-saving interventions under Global Health Initiatives, especially in weak health system contexts. They are frequently designed parallel to the health system to rapidly achieve programme targets such as vaccination coverage, but we lack quantitative evidence demonstrating their impact and effect mechanisms on health system performance at sub-/national level. This longitudinal study responds to this gap through an analysis of polio eradication campaigns in Nigeria. Methods Using four rounds of Demographic and Health Surveys in Nigeria between October 2000 and December 2017, we created a longitudinal dataset containing 88 881 under-5 children/pregnancies. We estimated the relationships between individuals’ campaign exposure and health system performance indices (full RI schedule attainment, maternal healthcare services utilisation and child survival) using multilevel, mixed-effects regression models applied nationally and stratified by the six geopolitical zones in Nigeria. Results Nationally, high-frequency mass campaigns had detrimental health systems effects that potentially left 3.6 million children deprived of full immunisation. The frequency of campaigns was most concentrated in regions with weak health systems, where the operations of RI were disrupted, alongside negative effects on child survival and institutional delivery. In contrast, regions with relatively strong health systems and few campaigns experienced beneficial effects on maternal healthcare service utilisation. Conclusions As we provide evidence that well-functioning health systems can benefit from mass campaigns under Global Health Initiatives, our work also challenges the established wisdom to intensify mass campaigns in weaker health systems to bypass service provision bottlenecks. Mass campaigns do not inherently benefit or damage a health system, but frequent campaigns in weak health system contexts can impede service provision. We call for an additional burden of proof and active efforts to integrate mass campaigns into routine health services by harmonising implementation plans and service delivery in weak health system contexts.
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Affiliation(s)
- Marco J Haenssgen
- Department of Global Sustainable Development, School of Cross-Faculty Studies, University of Warwick, Coventry, UK.,Institute of Advanced Study, Milburn House, University of Warwick, Coventry, UK
| | - Svea Closser
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olakunle Alonge
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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17
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Oteri AJ, Adamu U, Dieng B, Bawa S, Terna N, Nsubuga P, Owoaje ET, Kassogue M, Jean Baptiste AE, Braka F, Shuaib F. Nigeria experience on the use of polio assets for the 2017/18 measles vaccination campaign follow-up. Vaccine 2021; 39 Suppl 3:C3-C11. [PMID: 33962837 DOI: 10.1016/j.vaccine.2021.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public health challenges, including improving the quality and vaccination coverage of measles campaigns in order to reduce the incidences of measles in Nigeria. We documented the polio legacy and assets used to support the national measles campaign in 2017/2018. METHODS We documented the integration of the measles campaign coordination with the Polio Emergency Operation Centre (EOC) at national and state levels for planning and implementing the measles SIA. Specific polio strategies and assets, such as the EOC incident command framework and facilities, human resource surge capacity, polio GIS resource These strategies were adapted and adopted for the MVC implementation overcome challenges and improve vaccination coverage. We evaluated the performance through a set process and outcome indicators. RESULTS All the 36 states and Federal Capital Territory used the structure and resources in Nigeria and provided counterpart financing for the MVC 2017/ 2018. The 11 polio high-risk states deployed the use of GIS for microplanning process, while daily call-in data were tracked in 99.7% of the LGAs and 70,846 reports were submitted real-time by supervisors using Open data kit (ODK). The national coverage achieved was 87.5% by the post-campaign survey with 65% of states reporting higher coverage in 2018 compared to 2015. CONCLUSION Polio eradication assets and lessons learned can be applied to measles elimination efforts as the eradication and elimination efforts have similar strategies and programme implementation infrastructure needs. Leveraging these strategies and resources to support MVC planning and implementation resulted in more realistic planning, improved accountability and availability of human and fiscal resources. This approach may have resulted in better MVC outcomes and contributed to Nigeria's efforts in measles control and elimination.
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Affiliation(s)
| | - Usman Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunisations, Nigeria
| | - Samuel Bawa
- World Health Organisation, Country Office, Abuja, Nigeria.
| | | | | | - Eme T Owoaje
- College of Medicine, University of Ibadan. Nigeria
| | - Modibo Kassogue
- United Nations Children's Fund, Country Office, Abuja, Nigeria
| | | | - Fiona Braka
- World Health Organisation, Country Office, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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18
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Kwaja CMA, Olivieri DJ, Boland S, Henwood PC, Card B, Polatty DP, Levine AC. Civilian perception of the role of the military in Nigeria's 2014 Ebola outbreak and health-related responses in the North East region. BMJ Mil Health 2021; 169:e9-e14. [PMID: 33547194 DOI: 10.1136/bmjmilitary-2020-001696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Civilian-military relations play an important yet under-researched role in low-income and middle-income country epidemic response. One crucial component of civilian-military relations is defining the role of the military. This paper evaluates the role of Nigerian military during the 2014-2016 West African Ebola epidemic. METHODS Focus groups and key informant interviews were conducted throughout three states in North East region of Nigeria: Borno, Yobe and Adamawa. Participants were identified through mapping of stakeholder involvement in Nigerian epidemic response. English-translated transcripts of each key informant interview and focus group discussion were then coded and key themes were elucidated and analysed. RESULTS Major themes elucidated include developing inclusive coordination plans between civilian and military entities, facilitating human rights reporting mechanisms and distributing military resources more equitably across geographical catchment areas. The Nigerian Military served numerous functions: 37% (22/59) of respondents indicated 'security/peace' as the military's primary function, while 42% (25/59) cited health services. Variations across geographic settings were also noted: 35% (7/20) of participants in Borno stated the military primarily provided transportation, while 73% (11/15) in Adamawa and 29% (7/24) in Yobe listed health services. CONCLUSIONS Robust civilian-military relations require an appropriately defined role of the military and clear civilian-military communication. Important considerations to contextualise civilian-military relations include military cultural-linguistic understanding, human rights promotion, and community-based needs assessments; such foci can facilitate the military's understanding of community norms and civilian cooperation with military aims. In turn, more robust civilian-military relations can promote overall epidemic response and reduce the global burden of disease.
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Affiliation(s)
- Chris M A Kwaja
- Centre for Peace and Security Studies, Modibbo Adama University of Technology, Yola, Adamawa, Nigeria
| | - D J Olivieri
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Center for Human Rights and Humanitarian Studies, Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
| | - S Boland
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - P C Henwood
- Office of Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - B Card
- Center for Human Rights and Humanitarian Studies, Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
| | - D P Polatty
- Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
| | - A C Levine
- Center for Human Rights and Humanitarian Studies, Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
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19
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Boyce MR, Attal-Juncqua A, Lin J, McKay S, Katz R. Global Fund contributions to health security in ten countries, 2014-20: mapping synergies between vertical disease programmes and capacities for preventing, detecting, and responding to public health emergencies. LANCET GLOBAL HEALTH 2021; 9:e181-e188. [PMID: 33482139 PMCID: PMC8448292 DOI: 10.1016/s2214-109x(20)30420-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Global Fund to Fight AIDS, Tuberculosis and Malaria is a robust vertical global health programme. The extent to which vertical programmes financially support health security has not been investigated. We, therefore, endeavoured to quantify the extent to which the budgets of this vertical programme support health security. We believe this is a crucial area of work as the global community works to combine resources for COVID-19 response and future pandemic preparedness. METHODS We examined budgets for work in Kenya, Uganda, Vietnam, Democratic Republic of the Congo, Guatemala, Guinea, India, Indonesia, Nigeria, and Sierra Leone from January, 2014 to December, 2020. These ten countries were selected because of the robustness of investments and the availability of data. Using the International Health Regulations Joint External Evaluation (JEE) tool as a framework, we mapped budget line items to health security capacities. Two researchers independently reviewed each budget and mapped items to the JEE. Budgets were then jointly reviewed until a consensus was reached regarding if an item supported health security directly, indirectly, or not at all. The budgets for the study countries were inputted into a single Microsoft Excel spreadsheet and line items that mapped to JEE indicators were scaled up to their respective JEE capacity. Descriptive analyses were then done to determine the total amount of money budgeted for activities that support health security, how much was budgeted for each JEE capacity, and how much of the support was direct or indirect. FINDINGS The research team reviewed 37 budgets. Budgets totalled US$6 927 284 966, and $2 562 063 054 (37·0%) of this mapped to JEE capacities. $1 330 942 712 (19·2%) mapped directly to JEE capacities and $1 231 120 342 (17·8%) mapped indirectly to JEE capacities. Laboratory systems, antimicrobial resistance, and the deployment of medical countermeasures and personnel received the most overall budgetary support; laboratory systems, antimicrobial resistance, and workforce development received the greatest amount of direct budgetary support. INTERPRETATION Over one-third of the Global Fund's work also supports health security and the organisation has budgeted more than $2 500 000 000 for activities that support health security in ten countries since 2014. Although these funds were not budgeted specifically for health security purposes, recognising how vertical programmes can synergistically support other global health efforts has important implications for policy related to health systems strengthening. FUNDING Resolve to Save Lives: An Initiative of Vital Strategies.
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Affiliation(s)
- Matthew R Boyce
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Aurelia Attal-Juncqua
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Jessica Lin
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Stephanie McKay
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Rebecca Katz
- Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA.
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20
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Farooq RK, Rehman SU, Ashiq M, Siddique N, Ahmad S. Bibliometric analysis of coronavirus disease (COVID-19) literature published in Web of Science 2019-2020. J Family Community Med 2021; 28:1-7. [PMID: 33679183 PMCID: PMC7927969 DOI: 10.4103/jfcm.jfcm_332_20] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/05/2020] [Accepted: 09/11/2020] [Indexed: 01/29/2023] Open
Abstract
Coronavirus outbreak in Wuhan, China, turned into a pandemic in record time. Communication of disease presentation and mechanism of spread remain keys to getting ahead of the virus and limiting its spread beyond the capacity of management. Owing to huge academic focus and pandemic concern around the globe, this bibliometric analysis investigated research productivity related to coronavirus disease (COVID-19) pandemic using the Web of Science database. The relevant data were harvested, and search query was further refined by publication years (2020 OR 2019) and document types (article, book chapter, and proceedings paper). Finally, 6694 records were imported and downloaded in Plaintext and BibTeX formats on August 1, 2020. The data analysis was performed using MS Excel, VOS viewer, and Biblioshiny software. Of the 6694 publications that appeared in that period, the USA and Chinese research institutions topped the numbers. At the same time, the Journal of Medical Virology and CUREUS (Cureus Journal of Medical Science), remained favorite journals for publications. The pattern of multi-author publications has outstripped that of single-authors. Apart from COVID-19 and the novel coronavirus, the important keywords mentioned included pandemic, pneumonia, epidemiology, public health, outbreak, epidemic, China, infection, and treatment. The analysis shows a strong local research response from China, with large teams reporting on the disease outbreak. Subsequent studies will document a global response as the virus spreads worldwide. The initial research related to the current coronavirus outbreak was reported from within China. The data and patterns were supposed to alter as the virus spread globally.
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Affiliation(s)
- Rai K Farooq
- Department of Neuroscience Research, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shafiq Ur Rehman
- Deanship of Library Affairs, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Murtaza Ashiq
- Library and Information Science Department, Islamabad Model College for Boys, Islamabad, Pakistan
| | - Nadeem Siddique
- Gad & Birgit Rausing Library, Lahore University of Management Sciences, Lahore, Pakistan
| | - Shakil Ahmad
- Deanship of Library Affairs, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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21
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Warsame A, Murray J, Gimma A, Checchi F. The practice of evaluating epidemic response in humanitarian and low-income settings: a systematic review. BMC Med 2020; 18:315. [PMID: 33138813 PMCID: PMC7606030 DOI: 10.1186/s12916-020-01767-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemics of infectious disease occur frequently in low-income and humanitarian settings and pose a serious threat to populations. However, relatively little is known about responses to these epidemics. Robust evaluations can generate evidence on response efforts and inform future improvements. This systematic review aimed to (i) identify epidemics reported in low-income and crisis settings, (ii) determine the frequency with which evaluations of responses to these epidemics were conducted, (iii) describe the main typologies of evaluations undertaken and (iv) identify key gaps and strengths of recent evaluation practice. METHODS Reported epidemics were extracted from the following sources: World Health Organization Disease Outbreak News (WHO DON), UNICEF Cholera platform, Reliefweb, PROMED and Global Incidence Map. A systematic review for evaluation reports was conducted using the MEDLINE, EMBASE, Global Health, Web of Science, WPRIM, Reliefweb, PDQ Evidence and CINAHL Plus databases, complemented by grey literature searches using Google and Google Scholar. Evaluation records were quality-scored and linked to epidemics based on time and place. The time period for the review was 2010-2019. RESULTS A total of 429 epidemics were identified, primarily in sub-Saharan Africa, the Middle East and Central Asia. A total of 15,424 potential evaluations records were screened, 699 assessed for eligibility and 132 included for narrative synthesis. Only one tenth of epidemics had a corresponding response evaluation. Overall, there was wide variability in the quality, content as well as in the disease coverage of evaluation reports. CONCLUSION The current state of evaluations of responses to these epidemics reveals large gaps in coverage and quality and bears important implications for health equity and accountability to affected populations. The limited availability of epidemic response evaluations prevents improvements to future public health response. The diversity of emphasis and methods of available evaluations limits comparison across responses and time. In order to improve future response and save lives, there is a pressing need to develop a standardized and practical approach as well as governance arrangements to ensure the systematic conduct of epidemic response evaluations in low-income and crisis settings.
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Affiliation(s)
- Abdihamid Warsame
- Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London, UK.
| | - Jillian Murray
- Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London, UK
| | - Amy Gimma
- Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Checchi
- Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, London, UK
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22
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Oyeniran OI, Chia T. Fighting the Coronavirus disease (Covid-19) pandemic: Employing lessons from the Ebola virus disease response. ACTA ACUST UNITED AC 2020; 15:100558. [PMID: 32837995 PMCID: PMC7332950 DOI: 10.1016/j.jemep.2020.100558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 11/20/2022]
Abstract
Coronavirus disease (COVID-19) is caused by a beta-coronavirus (SARS-CoV-2) that affects the lower respiratory tract and appears as pneumonia in humans. COVID-19 became apparent in December 2019 in Wuhan City of China, and has propagated profusely globally. Despite stringent global quarantine and containment drives, the incidence of COVID-19 keeps soaring high. Measures to minimize human-to-human transmission have been implemented to control the pandemic. However, special efforts to reduce transmission via efficient public health communications and dissemination of risks should be applied in susceptible populations including children, health care providers, and the elderly. In response to this global pandemic, this article summarizes proven strategies that could be employed to combat the COVID-19 disease outbreak, taking a cue from lessons learned from the Ebola virus disease response.
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Affiliation(s)
- O I Oyeniran
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria
| | - T Chia
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria
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Eccleston-Turner M, Brassington I. Rights-Based Approaches to Preventing, Detecting, and Responding to Infectious Disease. INFECTIOUS DISEASES IN THE NEW MILLENNIUM 2020; 82. [PMCID: PMC7226904 DOI: 10.1007/978-3-030-39819-4_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Policymakers have come to look to human rights law in framing national health policy and global health governance. Human rights law offers universal frameworks to advance justice in public health, codifying international standards to frame government obligations and facilitate accountability for realising the highest attainable standard of health. Addressing threats to individual dignity as ‘rights violations’ under international law, health-related human rights have evolved dramatically to offer a normative framework for public health.
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Perry HB, Solomon R, Bisrat F, Hilmi L, Stamidis KV, Steinglass R, Weiss W, Losey L, Ogden E. Lessons Learned from the CORE Group Polio Project and Their Relevance for Other Global Health Priorities. Am J Trop Med Hyg 2019; 101:107-112. [PMID: 31760974 PMCID: PMC6776095 DOI: 10.4269/ajtmh.19-0036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 07/07/2019] [Indexed: 12/19/2022] Open
Abstract
Despite numerous setbacks, the Global Polio Eradication Initiative has implemented various community strategies with potential application for other global health issues. This article reviews strategies implemented by the CORE Group Polio Project (CGPP), including pursuit of the missed child, microplanning, independent campaign monitoring, using community health workers and community mobilizers to build community engagement, community-based surveillance, development of the capacity to respond to other health needs, targeting geographic areas at high risk, the secretariat model for non-governmental organization collaboration, and registration of vital events. These strategies have the potential for contributing to the reduction of child and maternal mortality in hard-to-reach, underserved populations around the world. Community-based surveillance as developed by the CGPP also has potential for improving global health security, now a global health priority.
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Affiliation(s)
- Henry B. Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roma Solomon
- CORE Group Polio Project/India, New Delhi, India
| | | | - Lisa Hilmi
- CORE Group, Washington, District of Columbia
| | | | | | - William Weiss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lee Losey
- CORE Group Polio Project, Washington, District of Columbia
| | - Ellyn Ogden
- United States Agency for International Development, Washington, District of Columbia
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Feachem RGA, Chen I, Akbari O, Bertozzi-Villa A, Bhatt S, Binka F, Boni MF, Buckee C, Dieleman J, Dondorp A, Eapen A, Sekhri Feachem N, Filler S, Gething P, Gosling R, Haakenstad A, Harvard K, Hatefi A, Jamison D, Jones KE, Karema C, Kamwi RN, Lal A, Larson E, Lees M, Lobo NF, Micah AE, Moonen B, Newby G, Ning X, Pate M, Quiñones M, Roh M, Rolfe B, Shanks D, Singh B, Staley K, Tulloch J, Wegbreit J, Woo HJ, Mpanju-Shumbusho W. Malaria eradication within a generation: ambitious, achievable, and necessary. Lancet 2019; 394:1056-1112. [PMID: 31511196 DOI: 10.1016/s0140-6736(19)31139-0] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/26/2019] [Accepted: 05/07/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Richard G A Feachem
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Ingrid Chen
- Global Health Group, University of California San Francisco, San Francisco, CA, USA.
| | - Omar Akbari
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - Amelia Bertozzi-Villa
- Malaria Atlas Project, University of Oxford, Oxford, UK; Institute for Disease Modeling, Bellevue, WA, USA
| | - Samir Bhatt
- Malaria Atlas Project, University of Oxford, Oxford, UK
| | - Fred Binka
- School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Maciej F Boni
- Center for Infectious Disease Dynamics, Department of Biology, Penn State, University Park, PA, USA
| | - Caroline Buckee
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Joseph Dieleman
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Arjen Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alex Eapen
- National Institute of Malaria Research, Chennai, India
| | - Neelam Sekhri Feachem
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Scott Filler
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Peter Gething
- Malaria Atlas Project, University of Oxford, Oxford, UK
| | - Roly Gosling
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Annie Haakenstad
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Kelly Harvard
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Arian Hatefi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Dean Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kate E Jones
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | | | | | - Altaf Lal
- Sun Pharma Industries, Mumbai, India
| | - Erika Larson
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Lees
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Neil F Lobo
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Angela E Micah
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Bruno Moonen
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Gretchen Newby
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Xiao Ning
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, China
| | - Muhammad Pate
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Martha Quiñones
- Department of Public Health, Universidad Nacional de Colombia, Bogota, Colombia
| | - Michelle Roh
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Ben Rolfe
- Asia Pacific Leaders Malaria Alliance, Singapore
| | | | - Balbir Singh
- Malaria Research Center, University Malaysia Sarawak, Sarawak, Malaysia
| | | | | | - Jennifer Wegbreit
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Hyun Ju Woo
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
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Nsubuga P, Masiira B, Ibrahim L, Ndakala N, Dongmo N. The contribution of the polio eradication initiative on the operations and outcomes of non-polio public health programs: a survey of programs in the African region. Pan Afr Med J 2019; 31:207. [PMID: 31447967 PMCID: PMC6691281 DOI: 10.11604/pamj.2018.31.207.17666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/20/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction The effect of the Global polio eradication initiative (PEI) on public health programs beyond polio is widely debated. PEI contribution to other health programs has been assessed from the perspective of polio-funded personnel, which may introduce bias as PEI staff are probably more likely to show that they have benefited of other programs. We set out to identify and document how public health programs have benefited from the public health capacity that was provided at the country level as part of the PEI program in a systematic and standardized manner. Methods Between July and November 2017, we conducted a mixed-methods cross-sectional study, which combined two methods: a multi-country quantitative survey and a qualitative study. We created a self-administered electronic multi-lingual questionnaire in English, French and Portuguese. The qualitative study, which followed an interim analysis of the quantitative survey, comprised interviews with national and subnational level staff in a few countries. Results A total of 127 public health workers from 43 of the 47 countries in the African WHO Region responded online. Most of the respondents 56/127 (42.7%) belonged to the immunization sector and 51/127 (38.9%) belonged to the emergencies and outbreaks sector. Respondents who identified themselves with the immunization (50/64 (78%)) and maternal health program (64/82 (78%)) reported the highest level of greatly benefiting from PEI resources. A total of 78/103 (76%) respondents rated PEI's contribution data management system to their program very high and high. Of the 127 respondents, the majority 91 (71.6%) reported that the withdrawal of PEI resources would result in a weakening of surveillance for other diseases; 88 (62.9%) reported that there would be inadequate resources to carry out planned activities and 80 (62.9%) reported that there would be poor logistics and transport for implementation of activities. Cameroon, DRC, Nigeria and Uganda participated in the qualitative study. Each country had between 7-8 key informants from the national and sub-national level for a total of 31 key informants. Polio funds and other PEI resources have supported various activities in the ministries of health of the four countries especially IDSR, data management, laboratories and development of the public health workforce. Respondents believed that the infrastructure and processes that PEI has created need to be maintained, along with the workforce and they believed that this was an essential role of their governments with support from the partners. Conclusion There is a high awareness of the PEI program in all the countries and at all levels which should be leveraged into improving other child survival activities for example routine immunizations. Future large-scale programs of this nature should be designed to benefit other public health programs beyond the specific program. The public health workforce, surveillance development, data management and laboratory strengthening that have been developed by PEI need to be maintained.
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Affiliation(s)
- Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, USA
| | - Ben Masiira
- Global Public Health Solutions, Atlanta, Georgia, USA
| | - Luka Ibrahim
- Global Public Health Solutions, Atlanta, Georgia, USA
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Bassey BE, Braka F, Vaz RG, Komakech W, Maleghemi ST, Koko R, Igbu T, Ireye F, Agwai S, Akpan GU, Tegegne SG, Mohammed AAG, Okocha-Ejeko A. The global switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV): facts, experiences and lessons learned from the south-south zone; Nigeria, April 2016. BMC Infect Dis 2018; 18:57. [PMID: 29374467 PMCID: PMC5787308 DOI: 10.1186/s12879-018-2963-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background The globally synchronized switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) took place in Nigeria on April 18th 2016. The country is divided into six geopolitical zones. This study reports the experiences and lessons learned from the switch process in the six states that make up Nigeria’s south-south geopolitical zone. Methods This was a descriptive retrospective review of Nigeria’s switch plan and structures used for implementing the tOPV-bOPV switch in the south-south zone. Nigeria’s National Polio Emergency Operation Centre (NPEOC) protocols, global guidelines and reports from switch supervisors during the switch were used to provide background information for this study. Quantitative data were derived from reviewing switch monitoring and validation documents as submitted to the NPEOC Results The switch process took place in all 3078 Health Facilities (HFs) and 123 Local Government Areas (LGAs) that make up the six states in the zone. A total of $139,430 was used for this process. The ‘healthcare personnel’ component received the highest budgetary allocation (59%) followed by the ‘logistics’ component (18%). Akwa Ibom state was allocated the highest number of healthcare personnel and hence received the most budgetary allocation compared to the six states (total healthcare personnel = 458, total budgetary allocation = $17,428). Validation of the switch process revealed that eight HFs in Bayelsa, Cross-River, Edo and Rivers states still possessed tOPV in cold-chain while six HFs in Cross-River and Rivers states had tOPV out of cold-chain but without the ‘do not use’ sticker. Akwa-Ibom was the only state in the zone to have bOPV and Inactivated Polio Vaccine (IPV) available in all its HFs monitored. Conclusion The Nigerian tOPV-bOPV switch was successful. For future Oral Polio Vaccine (OPV) withdrawals, implementation of the switch plan would be more feasible with an earlier dissemination of funds from global donor organizations, which would greatly aid timely planning and preparations. Increased budgetary allocation to the ‘logistics’ component to accommodate unexpected hikes in transportation prices and the general inefficiencies with power supply in the country is also advised.
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After polio: Imagining, planning, and delivering a world beyond eradication. Health Place 2018; 54:29-36. [DOI: 10.1016/j.healthplace.2018.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/29/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022]
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Kew O, Pallansch M. Breaking the Last Chains of Poliovirus Transmission: Progress and Challenges in Global Polio Eradication. Annu Rev Virol 2018; 5:427-451. [PMID: 30001183 DOI: 10.1146/annurev-virology-101416-041749] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Since the launch of the Global Polio Eradication Initiative (GPEI), paralytic cases associated with wild poliovirus (WPV) have fallen from ∼350,000 in 1988 to 22 in 2017. WPV type 2 (WPV2) was last detected in 1999, WPV3 in 2012, and WPV1 appeared to be localized to Pakistan and Afghanistan in 2017. Through continuous refinement, the GPEI has overcome operational and biological challenges far more complex and daunting than originally envisioned. Operational challenges had led to sustained WPV endemicity in core reservoirs and widespread dissemination to polio-free countries. The biological challenges derive from intrinsic limitations to the oral poliovirus vaccine: ( a) reduced immunogenicity in high-risk settings and ( b) genetic instability, leading to repeated outbreaks of circulating vaccine-derived polioviruses and prolonged infections in individuals with primary immunodeficiencies. As polio eradication enters its multifaceted endgame, the GPEI, with its technical, operational, and social innovations, stands as the preeminent model for control of vaccine-preventable diseases worldwide.
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Affiliation(s)
- Olen Kew
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA; ,
| | - Mark Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA; ,
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Hagan JE, Greiner A, Luvsansharav UO, Lake J, Lee C, Pastore R, Takashima Y, Sarankhuu A, Demberelsuren S, Smith R, Park B, Goodson JL. Use of a Diagonal Approach to Health System Strengthening and Measles Elimination after a Large Nationwide Outbreak in Mongolia. Emerg Infect Dis 2018; 23. [PMID: 29155667 PMCID: PMC5711310 DOI: 10.3201/eid2313.170594] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Measles is a highly transmissible infectious disease that causes serious illness and death worldwide. Efforts to eliminate measles through achieving high immunization coverage, well-performing surveillance systems, and rapid and effective outbreak response mechanisms while strategically engaging and strengthening health systems have been termed a diagonal approach. In March 2015, a large nationwide measles epidemic occurred in Mongolia, 1 year after verification of measles elimination in this country. A multidisciplinary team conducted an outbreak investigation that included a broad health system assessment, organized around the Global Health Security Agenda framework of Prevent-Detect-Respond, to provide recommendations for evidence-based interventions to interrupt the epidemic and strengthen the overall health system to prevent future outbreaks of measles and other epidemic-prone infectious threats. This investigation demonstrated the value of evaluating elements of the broader health system in investigating measles outbreaks and the need for using a diagonal approach to achieving sustainable measles elimination.
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Ajisegiri WS, Chughtai AA, MacIntyre CR. A Risk Analysis Approach to Prioritizing Epidemics: Ebola Virus Disease in West Africa as a Case Study. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:429-441. [PMID: 28810081 PMCID: PMC5949606 DOI: 10.1111/risa.12876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 06/02/2017] [Accepted: 06/17/2017] [Indexed: 05/23/2023]
Abstract
The 2014 Ebola virus disease (EVD) outbreak affected several countries worldwide, including six West African countries. It was the largest Ebola epidemic in the history and the first to affect multiple countries simultaneously. Significant national and international delay in response to the epidemic resulted in 28,652 cases and 11,325 deaths. The aim of this study was to develop a risk analysis framework to prioritize rapid response for situations of high risk. Based on findings from the literature, sociodemographic features of the affected countries, and documented epidemic data, a risk scoring framework using 18 criteria was developed. The framework includes measures of socioeconomics, health systems, geographical factors, cultural beliefs, and traditional practices. The three worst affected West African countries (Guinea, Sierra Leone, and Liberia) had the highest risk scores. The scores were much lower in developed countries that experienced Ebola compared to West African countries. A more complex risk analysis framework using 18 measures was compared with a simpler one with 10 measures, and both predicted risk equally well. A simple risk scoring system can incorporate measures of hazard and impact that may otherwise be neglected in prioritizing outbreak response. This framework can be used by public health personnel as a tool to prioritize outbreak investigation and flag outbreaks with potentially catastrophic outcomes for urgent response. Such a tool could mitigate costly delays in epidemic response.
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Affiliation(s)
- Whenayon Simeon Ajisegiri
- School of Public Health and Community Medicine, UNSW MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW MedicineUniversity of New South WalesSydneyNSWAustralia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, UNSW MedicineUniversity of New South WalesSydneyNSWAustralia
- College of Public Service & Community SolutionsArizona State UniversityPhoenixAZUSA
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Pigott DM, Deshpande A, Letourneau I, Morozoff C, Reiner RC, Kraemer MUG, Brent SE, Bogoch II, Khan K, Biehl MH, Burstein R, Earl L, Fullman N, Messina JP, Mylne AQN, Moyes CL, Shearer FM, Bhatt S, Brady OJ, Gething PW, Weiss DJ, Tatem AJ, Caley L, De Groeve T, Vernaccini L, Golding N, Horby P, Kuhn JH, Laney SJ, Ng E, Piot P, Sankoh O, Murray CJL, Hay SI. Local, national, and regional viral haemorrhagic fever pandemic potential in Africa: a multistage analysis. Lancet 2017; 390:2662-2672. [PMID: 29031848 PMCID: PMC5735217 DOI: 10.1016/s0140-6736(17)32092-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Predicting when and where pathogens will emerge is difficult, yet, as shown by the recent Ebola and Zika epidemics, effective and timely responses are key. It is therefore crucial to transition from reactive to proactive responses for these pathogens. To better identify priorities for outbreak mitigation and prevention, we developed a cohesive framework combining disparate methods and data sources, and assessed subnational pandemic potential for four viral haemorrhagic fevers in Africa, Crimean-Congo haemorrhagic fever, Ebola virus disease, Lassa fever, and Marburg virus disease. METHODS In this multistage analysis, we quantified three stages underlying the potential of widespread viral haemorrhagic fever epidemics. Environmental suitability maps were used to define stage 1, index-case potential, which assesses populations at risk of infection due to spillover from zoonotic hosts or vectors, identifying where index cases could present. Stage 2, outbreak potential, iterates upon an existing framework, the Index for Risk Management, to measure potential for secondary spread in people within specific communities. For stage 3, epidemic potential, we combined local and international scale connectivity assessments with stage 2 to evaluate possible spread of local outbreaks nationally, regionally, and internationally. FINDINGS We found epidemic potential to vary within Africa, with regions where viral haemorrhagic fever outbreaks have previously occurred (eg, western Africa) and areas currently considered non-endemic (eg, Cameroon and Ethiopia) both ranking highly. Tracking transitions between stages showed how an index case can escalate into a widespread epidemic in the absence of intervention (eg, Nigeria and Guinea). Our analysis showed Chad, Somalia, and South Sudan to be highly susceptible to any outbreak at subnational levels. INTERPRETATION Our analysis provides a unified assessment of potential epidemic trajectories, with the aim of allowing national and international agencies to pre-emptively evaluate needs and target resources. Within each country, our framework identifies at-risk subnational locations in which to improve surveillance, diagnostic capabilities, and health systems in parallel with the design of policies for optimal responses at each stage. In conjunction with pandemic preparedness activities, assessments such as ours can identify regions where needs and provisions do not align, and thus should be targeted for future strengthening and support. FUNDING Paul G Allen Family Foundation, Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development.
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Affiliation(s)
- David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ian Letourneau
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chloe Morozoff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Moritz U G Kraemer
- Department of Zoology, University of Oxford, Oxford, UK; Harvard Medical School, Harvard University, Boston, MA, USA; Boston Children's Hospital, Boston, MA, USA
| | - Shannon E Brent
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Isaac I Bogoch
- Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kamran Khan
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Molly H Biehl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jane P Messina
- School of Geography and the Environment, University of Oxford, Oxford, UK; School of Interdisciplinary Area Studies, University of Oxford, Oxford, UK
| | | | - Catherine L Moyes
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Freya M Shearer
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Samir Bhatt
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Oliver J Brady
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter W Gething
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Daniel J Weiss
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Andrew J Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK; Flowminder Foundation, Stockholm Sweden
| | | | - Tom De Groeve
- European Commission, Joint Research Centre, Ispra, Italy
| | | | - Nick Golding
- Quantitative and Applied Ecology Group, School of BioSciences, University of Melbourne, Parkville, VIC, Australia
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | | | - Edmond Ng
- Director's Office, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Piot
- Director's Office, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
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Modjarrad K, Vermund SH. Ensuring HIV Data Availability, Transparency and Integrity in the MENA Region Comment on "Improving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward". Int J Health Policy Manag 2017; 6:729-732. [PMID: 29172382 PMCID: PMC5726325 DOI: 10.15171/ijhpm.2017.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/24/2017] [Indexed: 12/18/2022] Open
Abstract
In this commentary, we elaborate on the main points that Karamouzian and colleagues have made about HIVdata scarcity in Middle Eastern and North African (MENA) countries. Without accessible and reliable data, no epidemic can be managed effectively or efficiently. Clearly, increased investments are needed to bolster capabilities to capture and interpret HIV surveillance data. We believe that this enhanced capacity can be achieved, in part, by leveraging and repurposing existing data platforms, technologies and patient cohorts. An immediate modest investment that capitalizes on available infrastructure can generate data on the HIV burden and spread that can be persuasive for MENA policy-makers to intensify efforts to track and contain the growing HIV epidemic in this region. A focus on key populations will yield the most valuable data, including among men who have sex with men (MSM), transgender women and men, persons who inject drugs (PWIDs), female partners of high risk men and female sex workers.
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Affiliation(s)
- Kayvon Modjarrad
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Sten H. Vermund
- Yale School of Public Health, Yale University, New Haven, CT, USA
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Seixas BV, Mitton C, Danis M, Williams I, Gold M, Baltussen R. Should Priority Setting Also Be Concerned About Profound Socio-Economic Transformations? A Response to Recent Commentary. Int J Health Policy Manag 2017; 6:733-734. [PMID: 29172383 PMCID: PMC5726326 DOI: 10.15171/ijhpm.2017.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/11/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Brayan V. Seixas
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Correspondence to: Brayan V. Seixas
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Marion Danis
- National Institutes of Health, Bethesda, MD, USA
| | | | - Marthe Gold
- New York Academy of Medicine, New York City, NY, USA
- City College, New York City, NY, USA
| | - Rob Baltussen
- Radboud University Medical Center, Nijmegen, The Netherlands
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Halliday JEB, Hampson K, Hanley N, Lembo T, Sharp JP, Haydon DT, Cleaveland S. Driving improvements in emerging disease surveillance through locally relevant capacity strengthening. Science 2017; 357:146-148. [PMID: 28706036 PMCID: PMC7612379 DOI: 10.1126/science.aam8332] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Emerging infectious diseases (EIDs) threaten the health of people, animals, and crops globally, but our ability to predict their occurrence is limited. Current public health capacity and ability to detect and respond to EIDs is typically weakest in low- and middle-income countries (LMICs). Many known drivers of EID emergence also converge in LMICs. Strengthening capacity for surveillance of diseases of relevance to local populations can provide a mechanism for building the cross-cutting and flexible capacities needed to tackle both the burden of existing diseases and EID threats. A focus on locally relevant diseases in LMICs and the economic, social, and cultural contexts of surveillance can help address existing inequalities in health systems, improve the capacity to detect and contain EIDs, and contribute to broader global goals for development.
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Affiliation(s)
- Jo E B Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Nick Hanley
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, Scotland, UK
| | - Tiziana Lembo
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Joanne P Sharp
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK
| | - Daniel T Haydon
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
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Thompson KM, Duintjer Tebbens RJ. Lessons From the Polio Endgame: Overcoming the Failure to Vaccinate and the Role of Subpopulations in Maintaining Transmission. J Infect Dis 2017; 216:S176-S182. [PMID: 28838194 PMCID: PMC5853387 DOI: 10.1093/infdis/jix108] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Recent detections of circulating serotype 2 vaccine-derived poliovirus in northern Nigeria (Borno and Sokoto states) and Pakistan (Balochistan Province) and serotype 1 wild poliovirus in Pakistan, Afghanistan, and Nigeria (Borno) represent public health emergencies that require aggressive response. Methods We demonstrate the importance of undervaccinated subpopulations, using an existing dynamic poliovirus transmission and oral poliovirus vaccine evolution model. We review the lessons learned during the polio endgame about the role of subpopulations in sustaining transmission, and we explore the implications of subpopulations for other vaccine-preventable disease eradication efforts. Results Relatively isolated subpopulations benefit little from high surrounding population immunity to transmission and will sustain transmission as long as they do not attain high vaccination coverage. Failing to reach such subpopulations with high coverage represents the root cause of polio eradication delays. Achieving and maintaining eradication requires addressing the weakest links, which includes immunizing populations in insecure areas and/or with disrupted or poor-performing health systems and managing the risks of individuals with primary immunodeficiencies who can excrete vaccine-derived poliovirus long-term. Conclusions Eradication efforts for vaccine-preventable diseases need to create performance expectations for countries to immunize all people living within their borders and maintain high coverage with appropriate interventions.Keywords. Polio; eradication; transmission; heterogeneity.
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Thompson KM. Modeling and Managing the Risks of Measles and Rubella: A Global Perspective Part II. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:1041-1051. [PMID: 28471528 DOI: 10.1111/risa.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 06/07/2023]
Abstract
Measles and rubella continue to circulate globally. Complementing Part I of the special issue, this introduction provides a contrast between other global eradication initiatives and the experience with measles and rubella eradication to date. This introduction builds on the syntheses of the literature provided in Part I and it describes the creation and application of a national risk assessment tool and the development of a dynamic disease transmission model to support global efforts to optimally manage measles and rubella globally using vaccines. Currently, efforts to eradicate measles and rubella suffer from the lack of a commitment to global eradication by key stakeholders, despite strong evidence that their eradication represents a better health and financial option than continued control.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc., Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
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Bali S, Stewart KA, Pate MA. Long shadow of fear in an epidemic: fearonomic effects of Ebola on the private sector in Nigeria. BMJ Glob Health 2016; 1:e000111. [PMID: 28588965 PMCID: PMC5321397 DOI: 10.1136/bmjgh-2016-000111] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/28/2016] [Indexed: 01/21/2023] Open
Abstract
Background The already significant impact of the Ebola epidemic on Guinea, Liberia and Sierra Leone, was worsened by a fear of contagion that aggravated the health crisis. However, in contrast to other Ebola-affected countries, Nigeria fared significantly better due to its swift containment of the disease. The objective of our study was to describe the impact of Ebola on the Nigerian private sector. This paper introduces and defines the term fearonomic effect as the direct and indirect economic effects of both misinformation as well as fear-induced aversion behaviour, exhibited by individuals, organisations or countries during an outbreak or an epidemic. Methods This study was designed as a cross-sectional mixed-methods study that used semistructured in-depth interviews and a supporting survey to capture the impact of Ebola on the Nigerian private sector after the outbreak. Themes were generated from the interviews on the direct and indirect impact of Ebola on the private sector; the impact of misinformation and fear-based aversion behaviour in the private sector. Results Our findings reveal that the fearonomic effects of Ebola included health service outages and reduced healthcare usage as a result of misinformation and aversion behaviour by both patients and providers. Although certain sectors (eg, health sector, aviation sector, hospitality sector) in Nigeria were affected more than others, no business was immune to Ebola's fearonomic effects. We describe how sectors expected to prosper during the outbreak (eg, pharmaceuticals), actually suffered due to the changes in consumption patterns and demand shocks. Conclusion In a high-stressor epidemic-like setting, altered consumption behaviour due to distorted disease perception, misinformation and fear can trigger short-term economic cascades that can disproportionately affect businesses and lead to financial insecurity of the poorest and the most vulnerable in a society.
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Affiliation(s)
- Sulzhan Bali
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kearsley A Stewart
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Muhammad Ali Pate
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,BigWin Philanthropy, Washington, District of Columbia, USA
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