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Timothy JWS, Pullan RL, Yotsu RR. Methods and Approaches for Buruli Ulcer Surveillance in Africa: Lessons Learnt and Future Directions. Methods Mol Biol 2022; 2387:87-102. [PMID: 34643905 DOI: 10.1007/978-1-0716-1779-3_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Over 95% of the global burden of Buruli ulcer disease (BU) caused by Mycobacterium ulcerans occurs in equatorial Africa. National and sub-national programs have implemented various approaches to improve detection and reporting of incident cases over recent decades. Regional incidence rates are currently in decline; however, surveillance targets outlined in 2012 by WHO have been missed and detection bias may contribute to these trends. In light of the new 2030 NTD roadmap and disease-specific targets, BU programs are required to strengthen case detection and begin a transition towards integration with other skin-NTDs. This transition comes with new opportunities to enhance existing BU surveillance systems and develop novel approaches for implementation and evaluation.In this review, we present a breakdown and assessment of the methods and approaches that have been the pillars of BU surveillance systems in Africa: (1) Passive case detection, (2) Data systems, (3) Clinical training, (4) Active case finding, (5) Burden estimation, and (6) Laboratory confirmation pathways. We discuss successes, challenges, and relevant case studies before highlighting opportunities for future development and evaluation including novel data collection tools, risk-based surveillance, and integrated skin-NTD surveillance. We draw on both experience and available literature to critically evaluate methods of BU surveillance in Africa and highlight new approaches to help achieve 2030 roadmap targets.
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Affiliation(s)
- Joseph W S Timothy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rie R Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, USA.
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Ukwaja KN, Alphonsus C, Eze CC, Lehman L, Ekeke N, Nwafor CC, Ikebudu J, Anyim MC, Chukwu JN. Investigating barriers and challenges to the integrated management of neglected tropical skin diseases in an endemic setting in Nigeria. PLoS Negl Trop Dis 2020; 14:e0008248. [PMID: 32352967 PMCID: PMC7217480 DOI: 10.1371/journal.pntd.0008248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/12/2020] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a dearth of experience in and evidence for cost-effective integrated community-based management of skin neglected tropical diseases (NTDs). The objective of this study was to assess the knowledge, attitude and care-seeking practices including self-care with a view to introducing appropriate community-based interventions for skin NTDs in an endemic setting in Southern Nigeria. METHODS/PRINCIPAL FINDINGS This exploratory study adopted a mixed-methods design consisting of cross-sectional surveys of community members and health workers using interviewer-administered questionnaires; and focus group discussions (FGDs) with community members, health care workers and patients with NTDs in Anambra State, Nigeria. The survey was completed by 353 community members (61.8% female) and 15 health care workers (100.0% female). A total of 52 individuals participated in six FGDs. Of the community members, 236 (66.9%) had heard or seen a case of leprosy; 324 (91.8%) and 131 (37.5%) had heard or seen a case of Buruli ulcer and lymphatic filariasis, respectively. Again, 213 (60.3%) of the respondents reported that the diseases were caused by witchcraft or curse. As regards prevention, 241 (68.3%) suggested avoiding handshake with affected persons. Up to 223 (63.2%) of respondents strongly agreed to the seriousness of skin NTDs in their community. Meanwhile, 272 (77.1%) of the respondents believed that the transmission of these skin NTDs can be prevented. Furthermore, 324 (91.7%) desired active community engagement for control of skin NTDs. Regarding community care seeking practices, 197 (55.8%) would first visit the health centre/hospital, followed by 91 (25.8%) traditional healer/herbalist and 35 (9.9%) pharmacy/patent medicine vendor if they develop a skin NTD. Overall, 332 (94.1%) of respondents expressed interest in being taught self-care practices for skin NTDs. Out of 15 healthcare workers, 13 (86.7%) were able to correctly diagnose two of these skin NTDs and 10 (66.7%) would encourage patients to practice self-care. Prominent themes in the FGDs were belief in witchcraft and herbal remedies; as well as the occurrence of physical, social and economic distress. CONCLUSIONS Our study helped quantify the information gaps that need to be addressed in order to create demand for integrated skin NTDs services in an endemic setting in Nigeria. Individual, structural and socioeconomic challenges to access and delivery of services were identified. Community and health care workers' empowerment and engagement through outreach and regular training, respectively may alleviate these challenges.
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Affiliation(s)
- Kingsley N. Ukwaja
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- * E-mail:
| | - Chukwuka Alphonsus
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Chinwe C. Eze
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Linda Lehman
- American Leprosy Missions, Greenville, South Carolina, United States of America
| | - Ngozi Ekeke
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Charles C. Nwafor
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Joy Ikebudu
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Moses C. Anyim
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Joseph N. Chukwu
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
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Trajman A, Wakoff-Pereira MF, Ramos-Silva J, Cordeiro-Santos M, Militão de Albuquerque MDF, Hill PC, Menzies D. Knowledge, attitudes and practices on tuberculosis transmission and prevention among auxiliary healthcare professionals in three Brazilian high-burden cities: a cross-sectional survey. BMC Health Serv Res 2019; 19:532. [PMID: 31362728 PMCID: PMC6668184 DOI: 10.1186/s12913-019-4231-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/07/2019] [Indexed: 01/27/2023] Open
Abstract
Background Tuberculosis elimination requires treatment of latently infected high-risk persons, such as contacts of index cases. Identification and referral of tuberculosis contacts for investigation are major barriers in the contact cascade-of-care. These tasks rely heavily on auxiliary primary healthcare workers in many low- and middle-income countries. We aimed to understand their knowledge, attitudes and practices (KAP) regarding contact investigation in Brazil. Methods We conducted a cross-sectional KAP survey on tuberculosis transmission and prevention among 135 auxiliary healthcare workers in three tuberculosis high-burden Brazilian cities. Trained interviewers applied a translated version of a previously applied questionnaire. Open answers were classified in pre-defined objective categories and analysed quantitatively. Answers were further classified as satisfactory or not according to criteria set by a panel of three specialists. Results Although 66% had received tuberculosis training in the past 10 years, only 19% were trained for tuberculosis prevention. 64% could not clearly distinguish latent tuberculosis infection (LTBI) from active tuberculosis; 63% did not know how to diagnose LTBI and 52% did not know how to prevent progression to active tuberculosis. Most believed that it is important to investigate adult (99%) and child (96%) contacts for LTBI. However, not all invite contacts - children (81%) or adults (71%) - to the clinic, despite only 24% perceiving difficulties for investigation. Conclusions Gaps in KAP among auxiliary health workers have been reported in other areas, such as obstetrics and other infectious diseases. To the best of our knowledge, this is the first KAP survey on tuberculosis transmission and prevention among auxiliary health care workers, and relevant gaps were also found. Knowledge gaps were notably related to LTBI management, including how to recognize it and prevent progression to active tuberculosis through treatment, despite most recognizing the importance of investigating contacts. Auxiliary healthcare workers in three Brazilian high-burden cities have important knowledge gaps despite their perception of the importance of tuberculosis prevention among contacts. They need to incorporate contact referral as one of their tasks to enable progress toward the target of tuberculosis elimination. Electronic supplementary material The online version of this article (10.1186/s12913-019-4231-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anete Trajman
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil. .,Respiratory Epidemiology & Clinical Research Unit (RECRU), McGill University, Montreal, Canada.
| | - Maria F Wakoff-Pereira
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil
| | - Jonas Ramos-Silva
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Universidade, Rio de Janeiro, Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, 22271-080, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Dourado Vieira, Universidade Estadual do Amazonas, Manaus, AM, Brazil
| | | | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Respiratory Epidemiology & Clinical Research Unit (RECRU), McGill University, Montreal, Canada
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Nwafor CC, Meka A, Chukwu JN, Ekeke N, Alphonsus C, Mbah O, Madichie NO, Aduh U, Ogbeifo M, IseOluwa-Adelokiki BO, Edochie JE, Ushaka J, Ukwaja KN. Assessment of community knowledge, attitude, and stigma of Buruli ulcer disease in Southern Nigeria. Afr Health Sci 2019; 19:2100-2111. [PMID: 31656494 PMCID: PMC6794545 DOI: 10.4314/ahs.v19i2.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Poor knowledge can influence timely care-seeking among persons with Buruli ulcer disease (BUD). Objectives To assess community knowledge, attitude and stigma towards persons with BUD in endemic settings of Southern Nigeria. Methods This was a cross-sectional survey conducted among adult community members in four States of Southern Nigeria. A semi-structured interviewer-administered questionnaire was administered to all participants. Results Of 491 adults who completed the survey, 315 (64.2%) belonged to the ≤40 years age group, 257 (52.3%) were males and 415 (84.5%) had some formal education. The overall mean (SD) knowledge score was 5.5±2.3 (maximum 10). Only 172 (35.0%) of the participants had a good knowledge of BUD. A total of 327 (66.6%) considered BUD as a very serious illness. Also, there was a high-level of stigma against BUD patients; 372 (75.8%) of the participants felt compassion for and desire to help them, 77 (15.7%) felt compassion but tended to stay away from them, and 53 (10.8%) feared them because they may infect them with the disease. Having a formal education and ethnicity were independent predictors of good knowledge of BUD. Conclusion There is poor community knowledge of BUD in endemic settings of Southern Nigeria which influenced the attitude and perceptions of community members towards persons with BUD
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Affiliation(s)
| | - Anthony Meka
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | - Joseph Ngozi Chukwu
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | - Ngozi Ekeke
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | - Chukwuka Alphonsus
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | - Obinna Mbah
- Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria
| | | | - Ufuoma Aduh
- Delta State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Delta State, Nigeria
| | - Matthew Ogbeifo
- Delta State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Delta State, Nigeria
| | | | | | - Joseph Ushaka
- Cross River State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Cross River State, Nigeria
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Nwankwo ONO, Mokogwu N, Agboghoroma O, Ahmed FO, Mortimer K. Knowledge, attitudes and beliefs about the health hazards of biomass smoke exposure amongst commercial food vendors in Nigeria. PLoS One 2018; 13:e0191458. [PMID: 29377962 PMCID: PMC5788333 DOI: 10.1371/journal.pone.0191458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/07/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Exposure to biomass smoke is a major cause of morbidity and mortality in Africa. Commercial food vendors in Nigeria and elsewhere in Africa are commonly exposed to biomass smoke from open fire cooking both at work and home. Little is known about the knowledge, attitudes and beliefs of food vendors about the health hazards of biomass smoke exposure in Nigeria. METHODS We did a descriptive cross sectional survey of the knowledge, attitudes and beliefs of commercial food vendors in the cities of Benin and Calabar in Nigeria. We recruited respondents using a multi-stage approach. Structured interviewer-administered questionnaires were used for data collection. RESULTS We recruited 308 participants (164, 53.2% female). The majority 185(60.2%) were married and had post-primary education 206(67.4%). The average monthly income was <30,000 Naira (US$150). Most 198(64.4%) were not aware that biomass smoke exposure is harmful to human health. About three-quarters (221; 71.8%) were unconcerned as to the effect of exposure to fumes from biomass fuels on their health. Less than half of respondents (110, 41.6%) believed biomass smoke was harmful to health. Male gender, being single, having post-primary education and preferring electricity or gas fuels were associated with good knowledge of the adverse health effects of biomass smoke exposure whilst female gender and having good knowledge of the adverse health effects of biomass smoke were associated with positive attitudes towards preventing exposure. CONCLUSION Commercial food vendors in our study had limited knowledge about the adverse health effects of biomass smoke exposure and negative attitudes towards preventing these adverse health effects. We suggest an educational intervention is needed to improve this knowledge.
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Affiliation(s)
- Ogonna N. O. Nwankwo
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ndubuisi Mokogwu
- Department of Community Health, University of Benin Teaching Hospital, Benin, Nigeria
| | | | - Fahmi O. Ahmed
- College Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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