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Tomlinson M, Marlow M, Stewart J, Makhetha M, Sekotlo T, Mohale S, Lombard C, Murray L, Cooper PJ, Morley N, Rabie S, Gordon S, van der Merwe A, Bachman G, Hunt X, Sherr L, Cluver L, Skeen S. A community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho (Early Morning Star): a cluster-randomised, controlled trial. Lancet HIV 2024; 11:e42-e51. [PMID: 38142113 DOI: 10.1016/s2352-3018(23)00265-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND When caregivers live in remote settings characterised by extreme poverty, poor access to health services, and high rates of HIV/AIDS, their caregiving ability and children's development might be compromised. We aimed to test the effectiveness of a community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho. METHODS We implemented a matched cluster-randomised, controlled trial in the Mokhotlong district in northeastern Lesotho with 34 community clusters randomly assigned to intervention or wait-list control groups within a pair. Eligible clusters were villages with non-governmental organisation partner presence and an active preschool. Participants were caregiver-child dyads, where the child was 12-60 months old at baseline. The intervention consisted of eight group sessions delivered at informal preschools to all children in each village. Mobile health events were hosted for all intervention (n=17) and control (n=17) clusters, offering HIV testing and other health services to all community members. Primary outcomes were caregiver-reported child HIV testing, child language development, and child attention. Assessments were done at baseline, immediately post-intervention (3 months post-baseline), and 12 months post-intervention. We assessed child language by means of one caregiver-report measure (MacArthur-Bates Communicative Development Inventory [CDI]) and used two observational assessments of receptive language (the Mullen Scales of Early Learning receptive language subscale, and the Peabody Picture Vocabulary Test 4th edn). Child attention was assessed by means of the Early Childhood Vigilance Task. Assessors were masked to group assignment. Analysis was by intention to treat. This trial was registered with ISRCTN.com, ISRCTN16654287 and is completed. FINDINGS Between Aug 8, 2015, and Dec 10, 2017, 1040 children (531 intervention; 509 control) and their caregivers were enrolled in 34 clusters (17 intervention; 17 control). Compared with controls, the intervention group reported significantly higher child HIV testing at the 12-month follow-up (relative risk [RR] 1·46, 95% CI 1·29 to 1·65, p<0·0001), but not immediately post-intervention. The intervention group showed significantly higher child receptive language on the caregiver report (CDI) at immediate (effect size 3·79, 95% CI 0·78 to 6·79, p=0·028) but not at 12-month follow-up (effect size 2·96, 95% CI -0·10 to 5·98, p=0·056). There were no significant group differences for the direct assessments of receptive language. Child expressive language and child attention did not differ significantly between groups. INTERPRETATION Integrated child health and parenting interventions, delivered by trained and supervised lay health workers, can improve both child HIV testing and child development. FUNDING United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR).
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Affiliation(s)
- Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jackie Stewart
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Moroesi Makhetha
- Institute for Life Course Health Research Lesotho Satellite Site, Stellenbosch University, Maseru, Lesotho
| | - Tholoana Sekotlo
- Institute for Life Course Health Research Lesotho Satellite Site, Stellenbosch University, Maseru, Lesotho
| | - Sebuoeng Mohale
- Institute for Life Course Health Research Lesotho Satellite Site, Stellenbosch University, Maseru, Lesotho
| | - Carl Lombard
- Division of Epidemiology and Biostatistics, Stellenbosch University, Belleville, South Africa; Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lynne Murray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Nathene Morley
- Baylor International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, Texas, USA
| | - Stephan Rabie
- HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Sarah Gordon
- Centre for Evidence-Based Health Care, Stellenbosch University, Belleville, South Africa
| | - Amelia van der Merwe
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gretchen Bachman
- Office of Global HIV/AIDS, US Agency for International Development, Washington, DC, USA
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Lucie Cluver
- Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
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Hodgins S, Kok M, Musoke D, Lewin S, Crigler L, LeBan K, Perry HB. Community health workers at the dawn of a new era: 1. Introduction: tensions confronting large-scale CHW programmes. Health Res Policy Syst 2021; 19:109. [PMID: 34641886 PMCID: PMC8506102 DOI: 10.1186/s12961-021-00752-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Community health worker (CHW) programmes are again receiving more attention in global health, as reflected in important recent WHO guidance. However, there is a risk that current CHW programme efforts may result in disappointing performance if those promoting and delivering them fail to learn from past efforts. This is the first of a series of 11 articles for a supplement entitled "Community Health Workers at the Dawn of a New Era". METHODS Drawing on lessons from case studies of large well-established CHW programmes, published literature, and the authors' experience, the paper highlights major issues that need to be acknowledged to design and deliver effective CHW programmes at large scale. The paper also serves as an introduction to a set of articles addressing these issues in detail. RESULTS The article highlights the diversity and complexity of CHW programmes, and offers insights to programme planners, policymakers, donors, and others to inform development of more effective programmes. The article proposes that be understood as actors within community health system(s) and examines five tensions confronting large-scale CHW programmes; the first two tensions concern the role of the CHW, and the remaining three, broader strategic issues: 1) What kind of an actor is the CHW? A lackey or a liberator? Provider of clinical services or health promoter? 2) Lay versus professional? 3) Government programme at scale or nongovernmental organization-led demonstration project? 4) Standardized versus tailored to context? 5) Vertical versus horizontal? CONCLUSION CHWs can play a vital role in primary healthcare, but multiple conditions need to be met for them to reach their full potential.
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Affiliation(s)
- Stephen Hodgins
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Maryse Kok
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo Town, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lauren Crigler
- Crigler Consulting, LLC, Hillsborough, NC, United States of America
| | - Karen LeBan
- Independent Consultant, Washington, DC, United States of America
| | - Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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Idris IO, Obwoya JG, Tapkigen J, Lamidi SA, Ochagu VA, Abbas K. Impact evaluation of immunisation service integration to nutrition programmes and paediatric outpatient departments of primary healthcare centres in Rumbek East and Rumbek Centre counties of South Sudan. Fam Med Community Health 2021; 9:fmch-2021-001034. [PMID: 34433617 PMCID: PMC8388298 DOI: 10.1136/fmch-2021-001034] [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] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the impact of immunisation service integration to nutrition programmes and under 5-year-old paediatric outpatient departments of primary healthcare centres in Rumbek East and Rumbek Centre counties of South Sudan. Design Retrospective intervention study. Setting Three primary healthcare centres in Rumbek East county and three primary healthcare centres in Rumbek Centre county of Lakes state in South Sudan. Participant We extracted the data for the uptake of pentavalent vaccine (first, second and third dose) given to children aged between 6 weeks and 23 months from immunisation records for January–June 2019 before immunisation service integration and July–December 2019 after immunisation service integration from the District Health Information System 2 website to estimate the immunisation uptake ratios and drop-out rates. Results The uptake of the first dose of the pentavalent vaccine improved from 61% to 96% (p<0.001) after immunisation service integration into the nutrition programmes of the primary healthcare centres in Rumbek Centre county. The uptake of the second pentavalent dose improved from 37% to 69% (p<0.001) and for the third pentavalent dose from 36% to 62% (p<0.001), while the drop-out rate reduced from 57% to 40% (p<0.001). While in Rumbek East county, the uptake of the first dose of the pentavalent vaccine improved from 55% to 77% (p<0.001) after immunisation service integration into the under 5-year-old paediatric outpatient departments. The uptake of the second dose improved from 36% to 62% (p<0.001) and for the third dose from 44% to 63% (p<0.001), while the drop-out rate reduced from 40% to 28% (p<0.001). Children were 23% more likely (RR 1.23, 95% CI 1.12 to 1.36, p<0.001) to be immunised with the first dose of the pentavalent vaccine on immunisation service integration into the nutrition programmes of primary healthcare centres of Rumbek Centre county in comparison to integration into under 5-year-old outpatient departments of Rumbek East county. Conclusion Integration of immunisation service delivery to nutrition sites and children’s outpatient departments improved the immunisation coverage and decreased drop-out rates in the Rumbek East and Rumbek Centre counties of South Sudan. This evidence of positive impact should encourage the stakeholders of the Expanded Programme on Immunisation to focus on the sustainability and scale-up of this intervention to other counties in South Sudan, as logistically as possible.
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Affiliation(s)
- Israel Oluwaseyidayo Idris
- Health Policy Unit, Department of Public Administration and State Management, Simon Kuznets Kharkiv National University of Economics, Kharkiv, Ukraine .,Department of Preventive Medicine and Community Health, V N Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Justin Geno Obwoya
- Department of Field Operation and Project Coordination, Health Pooled Fund, Rumbek, South Sudan
| | - Janet Tapkigen
- Department of Nutrition for Global Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Serifu Ayobami Lamidi
- Department of Epidemiology and Medical Statistics, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Victor A Ochagu
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kaja Abbas
- Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK
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Abdullahi LH, Rithaa GK, Muthomi B, Kyallo F, Ngina C, Hassan MA, Farah MA. Best practices and opportunities for integrating nutrition specific into nutrition sensitive interventions in fragile contexts: a systematic review. BMC Nutr 2021; 7:46. [PMID: 34321101 PMCID: PMC8320180 DOI: 10.1186/s40795-021-00443-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Annually, undernutrition contributes globally to 45% (3.1 million) of preventable deaths in children under 5. Effect following undernutrition i.e. physical growth & cognitive development etc. can be prevented during the first 1000 days also called window of opportunity. There is substantial evidence of positive nutrition outcomes resulting from integrating nutrition-specific interventions into nutrition specific program. However, there is paucity of knowledge on establishing and sustaining effective integration of nutrition intervention in fragile context. The objective of this review is to map and review the integration of nutrition-specific intervention to nutrition sensitive program and its impacts on nutrition outcomes. Methods In the study, we systematically searched the literature on integrated nutrition intervention into multi-sectoral programme in PUBMED, Google’s Scholar, the Cochrane Library, World Health Organisation (WHO), United Nations Children’s Fund (UNICEF), World Bank and trial registers from their inception until Oct 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. This study is registered with PROSPERO (CRD42020209730). Result Forty-four studies were included in this review, outlining the integration of nutrition-specific interventions among children 0–59 months with various existing programme. Most common integration platform in the study included integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with a number of model of integration which varies according to the context and demands of the particular setting in which integration occurs. Conclusion Overall, existing evidence for nutrition sensitive and specific interventions is not robust and remains limited. It’s worthwhile to note, for future studies/interventions should be based on the context key criteria like relevance, political support, effectiveness, feasibility, expected contribution to health system strengthening, local capacities, ease of integration and targeting for sustainability, cost effectiveness and financial availability. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00443-1.
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Affiliation(s)
| | - Gilbert K Rithaa
- Horn Population Research & Development (HPRD), Mogadishu, Somalia
| | - Bonface Muthomi
- Horn Population Research & Development (HPRD), Mogadishu, Somalia
| | - Florence Kyallo
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Clementina Ngina
- Independent nutrition consultant, Nairobi, Kenya.,Independent nutrition consultant, Mogadishu, Somalia
| | - Mohamed A Hassan
- Scaling Up Nutrition (SUN), Office of Prime Minister, Mogadishu, Somalia
| | - Mohamed A Farah
- Scaling Up Nutrition (SUN), Office of Prime Minister, Mogadishu, Somalia
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Bauck A, Jalloh UH, Kargbo A, Hodges MH, Doledec D. Gender intersections identified whilst transitioning mass vitamin A supplementation into an integrated reproductive and child health programme in Sierra Leone. Health Policy Plan 2021; 36:673-683. [PMID: 33847742 DOI: 10.1093/heapol/czab037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/03/2020] [Accepted: 03/15/2021] [Indexed: 11/12/2022] Open
Abstract
Since 2006, Sierra Leone has achieved high rates of vitamin A supplementation (VAS) coverage (>88%) during mass campaigns. In 2017, campaigns started transitioning to routine VAS within a six-monthly contact point for integrated reproductive and child health (RCH) services. This contact point included improved counselling and provision of modern contraceptives; throughout this transition high VAS coverage (>85%) has been maintained. VAS programmes have traditionally operated on the assumption that they are gender-neutral, but recent research suggests these programmes should re-examine how they interact with gender. This qualitative study examined intersections between gender and Sierra Leone's integrated VAS programming by conducting 32 individual interviews with parents, district health management and national staff, and six focus group discussions with health workers and community health workers (CHWs) in three pilot program districts. The study found that most senior health positions are held by males, and the lower cadres of majority female health workers often felt unsupported/disrespected by their male superiors and male CHW supervisees, or that their years of experience were overlooked in favour of the academic qualifications of less experienced male colleagues. Gender was not included in program training, and most staff did not have a good understanding of gender intersections; however, health workers actively engaged in awareness raising with male stakeholders to increase male involvement in RCH. Routine delivery requires mothers to invest time and money to access health facilities, where most mothers felt that better qualified staff were able to offer better advice and more services. Health workers felt that outreach services utilizing CHWs could decrease this time/money burden; however, CHWs are unqualified to provide counselling and provision of modern contraception, and there are fewer female CHWs. Records kept in health facilities record VAS by sex, but monthly reports submitted to the district and onwards to the national Health Management Information System are not disaggregated by sex. Programme and policymakers should consider improving the representation by females in senior, decision-making positions, integrating gender information into all trainings, supporting female health workers, training and recruiting more female CHWs, and reporting VAS coverage by sex.
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Affiliation(s)
- Aubrey Bauck
- Helen Keller International - Regional Office, 122 Toundoup Rya, BP 29.898, Dakar, Senegal
| | - Umu H Jalloh
- Helen Keller International, 35 Nelson Lane, Freetown, Sierra Leone
| | - Anita Kargbo
- Helen Keller International, 35 Nelson Lane, Freetown, Sierra Leone
| | - Mary H Hodges
- Helen Keller International, 35 Nelson Lane, Freetown, Sierra Leone
| | - David Doledec
- Helen Keller International - Regional Office, Nairobi, Kenya
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Hodgins S, Klemm R. Micronutrient Powders for Infants and Young Children. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:216-219. [PMID: 34048361 PMCID: PMC8324200 DOI: 10.9745/ghsp-d-21-00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 12/02/2022]
Abstract
Providing standalone micronutrient products for household use is not an easy strategy, but under the right conditions, it can work. To be effective, micronutrient powder programs require robust commodity logistics and support of uptake and adherence.
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Affiliation(s)
- Stephen Hodgins
- Editor-in-Chief, Global Health: Science and Practice Journal, and Associate Professor, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | - Rolf Klemm
- Helen Keller International, New York, NY, USA
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Mupere E, Babikako HM, Okaba-Kayom V, Mutyaba RB, Mwisaka MN, Tenywa E, Lule A, Aceng JR, Mpanga-Kaggwa F, Matseketse D, Aga E. Family Health Days program contributions in vaccination of unreached and under-immunized children during routine vaccinations in Uganda. PLoS One 2020; 15:e0218239. [PMID: 31951608 PMCID: PMC6968838 DOI: 10.1371/journal.pone.0218239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background We explored the contributions of the Family Health Days (FHDs) concept, which was developed by the Uganda Ministry of Health (MOH) and UNICEF as a supplementary quarterly outreach program in addition to strengthening the routine expanded program for immunization (EPI), with the aim to increase coverage, through improved access to the unimmunized or unreached and under-immunized children under 5 years. Method A cross-sectional descriptive study of the Uganda MOH, Health Management Information Systems (HMIS) and UNICEF in house FHDs data was conducted covering six quarterly implementations of the program between April 2012 and December 2013. The FHDs program was implemented in 31 priority districts with low routine vaccination coverage from seven sub-regions in Uganda in a phased manner using places of worship for service delivery. Results During the six rounds of FHDs in the 31 districts, a total of 178,709 and 191,223 children received measles and Diphtheria-Pertussis-Tetanus (DPT3) vaccinations, respectively. The FHDs’ contributions were 126% and 144% for measles and 103% and 122% for DPT3 in 2012 and 2013, respectively of the estimated unreached annual target populations. All implementing sub-regions after two rounds in 2012 attained over and above the desired target for DPT3 (85%) and measles (90%). The same was true in 2013 after four rounds, except for Karamoja and West Nile sub-regions, where in some districts a substantial proportion of children remained unimmunized. The administrative data for both DPT3 and measles immunization showed prominent and noticeable increase in coverage trend in FHDS regions for the months when the program was implemented. Conclusion The FHDs program improved vaccination equity by reaching the unreached and hard-to-reach children and bridging the gap in immunization coverage, and fast tracking the achievement of targets recommended by the Global Vaccine Action Plan (GVAP) for measles and DPT3 (85% and 90% respectively) in implementing sub-regions and districts. The FHDs is an innovative program to supplement routine immunizations designed to reach the unreached and under immunized children.
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Affiliation(s)
- Ezekiel Mupere
- Department of Paediatrics & Child Health College of Health Sciences, Makerere University, Kampala, Uganda
- Research and Data System Center, Child and Family Foundation Uganda, Kampala, Uganda
- * E-mail:
| | - Harriet M. Babikako
- Research and Data System Center, Child and Family Foundation Uganda, Kampala, Uganda
- Child Health and Development Center College of Health Sciences, Makerere University, Kampala, Uganda
| | - Violet Okaba-Kayom
- Department of Paediatrics & Child Health College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert B. Mutyaba
- Information Systems and Programming, RBMTM Systems Consult Limited, Kampala, Uganda
| | | | - Emmanuel Tenywa
- Paediatrics, Jinja Regional Referral Hospital Ministry of Health, Jinja, Uganda
| | - Albert Lule
- Nutrition Unit, Ministry of Health, Kampala, Uganda
| | | | | | | | - Eresso Aga
- Health Manager, UNICEF Jordan Country Office, Amman, Jordan
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Nordhagen S, Bauck A, Doledec D. Gender Equity and Vitamin A Supplementation: Moving Beyond Equal Coverage. Food Nutr Bull 2019; 41:38-49. [DOI: 10.1177/0379572119860310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Vitamin A supplementation (VAS) is currently implemented in over 80 countries worldwide, but little attention has been paid to gender equity in the design or implementation of these programs. Objective: This article describes the ways in which gender equity can impact or be impacted by VAS programs and suggests ways to ensure these programs better support gender equity in the future. Methods: We undertook a desk review of research on gender equity in health services and extrapolated findings to VAS, highlighting gender equity issues throughout the VAS implementation process and across delivery platform types. We also amassed secondary data on VAS coverage from 45 surveys in 13 countries and analyzed it to examine differences in VAS coverage between boys and girls. Results: Despite few significant differences in coverage between boys and girls, we identify numerous ways in which gender equity can impact or be impacted by VAS programs, including through the choice of VAS distributors and the communication materials used to promote VAS campaigns. Examining these different entry points reveals that there are several missed opportunities for better integration of gender within VAS. Conclusions: VAS program implementers and policymakers should revisit VAS approaches to identify opportunities for advancing gender equity through this wide-reaching platform.
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Affiliation(s)
- Stella Nordhagen
- Africa Regional Office, Helen Keller International, Dakar, Senegal
| | - Aubrey Bauck
- Africa Regional Office, Helen Keller International, Dakar, Senegal
| | - David Doledec
- Africa Regional Office, Helen Keller International, Nairobi, Kenya
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Kamatsuchi M, Gheorghe A, Balabanova D. The global scale and implications of delivering multiple interventions through integrated child health events. BMJ Glob Health 2019; 4:e001333. [PMID: 31354970 PMCID: PMC6615908 DOI: 10.1136/bmjgh-2018-001333] [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: 11/28/2018] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Delivering child health services through integrated child health events (ICHEs) has been a useful and popular strategy implemented in many in low-income and middle-income countries (LMICs) to accelerate the reduction of child mortality. The study aims to portray the scope of ICHEs and examine the association between the number of child health-nutrition interventions and types of ICHE packages delivered through these campaigns with vitamin A supplementation (VAS) and measles vaccination. Methods Secondary data analysis was conducted using Unicef global campaign database (1999–2010), where 597 ICHEs from 76 countries were analysed. Panel random effects regression models were used to explore the association between the number of interventions and coverage for VAS and measles vaccination, and non-parametric Kruskal-Wallis test to explore the association between different intervention packages and VAS coverage. Results An average of 100 ICHEs were conducted per year between 2005 and 2010, highest in sub-Saharan Africa (60%). By 2010, 40 ICHEs out of 66 (60%) across 24 countries delivered 5 or more interventions during 1 ICHE. No statistically significant effect of the number of ICHE interventions on VAS coverage was found (−0·76, p=0·185). There was a small significant effect on measles coverage (−1·81, p=0·057), which was not robust to model specifications removing outlier observations with measles coverage lower than 40%. The Kruskal-Wallis test did not suggest a significant association between different intervention packages and VAS coverage at 5% significance level (p=0·07). Conclusion ICHEs were found to be a widely used strategy to deliver essential child health-nutrition interventions in LMICs. ICHEs appear to represent a commonly used platform with the capacity to incorporate multiple interventions without compromising coverage of some key interventions as VAS and measles vaccination. More research is required to better understand what operational factors may affect the coverage outcomes delivered together through ICHEs.
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Affiliation(s)
- Mahoko Kamatsuchi
- Health, Nutrition and Population, World Bank Group, Washington, District of Columbia, USA
| | - Adrian Gheorghe
- Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Dina Balabanova
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Dissieka R, Soohoo M, Janmohamed A, Doledec D. Providing mothers with mobile phone message reminders increases childhood immunization and vitamin A supplementation coverage in Côte d'Ivoire: A randomized controlled trial. J Public Health Afr 2019; 10:1032. [PMID: 31285815 PMCID: PMC6589636 DOI: 10.4081/jphia.2019.1032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/17/2019] [Indexed: 11/22/2022] Open
Abstract
We conducted a randomized controlled trial to assess the effect of providing mothers with mobile voice or text (SMS) reminder messages on health facility attendance at five infant immunization and vitamin A supplementation (VAS) visits. The study was conducted at 29 health facilities in Korhogo district. Mothers were randomized to receive a voice or text reminder message two days prior to each scheduled visit and two additional reminders for missed doses (n=798; intervention group), or no phone reminder messages (n=798; control group). Infants in the intervention group were 2.85 (95% CI: 1.85-4.37), 2.80 (95% CI: 1.88-4.17), 2.68 (95% CI: 1.84-3.91), and 4.52 (95% CI: 2.84-7.20) times more likely to receive pentavalent 1-3 and MMR/yellow fever doses, respectively, and 5.67 (95% CI: 3.48-9.23) times more likely to receive VAS, as compared to the control group. In the reminder group, 58.3% of infants completed all five visits, compared to 35.7% in the control group (P<0.001). Providing mothers mobile phone message reminders is a potentially effective strategy for improving immunization and VAS coverage in Cote d’Ivoire.
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Affiliation(s)
| | | | | | - David Doledec
- Helen Keller International, Isaac Gathanju Road, Nairobi, Kenya
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de Miranda WD, Guimarães EAA, Campos DS, Antero LS, Beltão NRM, da Luz ZMP. [Vitamin A Supplementation Program in Brazil: evaluability assessmentPrograma Nacional de Suplementación de Vitamina A en Brasil: un estudio de evaluación]. Rev Panam Salud Publica 2019; 42:e182. [PMID: 31093210 PMCID: PMC6385853 DOI: 10.26633/rpsp.2018.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/07/2018] [Indexed: 11/24/2022] Open
Abstract
Objetivo Descrever as etapas do estudo de avaliabilidade do Programa Nacional de Suplementação de Vitamina A (PNSVA) no Brasil. Métodos Estudo com abordagem qualitativa que adotou como referencial o sistema de sete elementos proposto por Thurston e Ramaliu. Foram realizados análise de documentos, revisão teórica sobre o PNSVA e encontros com referências técnicas para a elaboração da linha do tempo e modelos teórico e lógico do Programa. O modelo lógico subsidiou a elaboração de dois questionários a serem utilizados para avaliar a implantação do PNSVA. Foi realizada a validação de conteúdo das perguntas avaliativas dos questionários por meio da técnica Delphi. Resultados O estudo possibilitou compreender a evolução das estratégias para prevenção e controle da deficiência de vitamina A no país, além do funcionamento do PNSVA e seu contexto externo. O modelo lógico revelou-se uma ferramenta valiosa para identificar áreas específicas que devem ser priorizadas em avaliações futuras. A validação dos questionários indicou que esses instrumentos abordam questões necessárias para a avaliação da implantação do Programa em municípios. A etapa da técnica Delphi foi de grande importância para guiar ajustes pertinentes quanto ao conteúdo e à forma de apresentação de algumas questões, o que certamente aumentará o poder analítico da ferramenta. Conclusão O estudo de avaliabilidade apontou a possibilidade de avaliações posteriores do PNSVA. Espera-se que os resultados desta investigação auxiliem futuras avaliações em países que adotam ações semelhantes às do Brasil.
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Affiliation(s)
| | | | | | - Laís Santos Antero
- Secretaria de Estado de Saúde de Minas Gerais (SES - MG), Belo Horizonte (MG), Brasil
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Kaliwile C, Arscott SA, Gannon BM, Masi C, Tanumihardjo SA. Community mobilization during biofortified orange maize feeding trials in Zambia. INT J VITAM NUTR RES 2019; 90:257-265. [PMID: 30806607 DOI: 10.1024/0300-9831/a000541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In some societies, studies involving blood draws, oral vaccinations, or supplementation are surrounded by myths and disbeliefs. If not clarified, they may affect study implementation and negatively impact the outcome of well-intended studies from inadequate participation. Through participatory action research, this paper suggests how future trials could be enhanced with reference to community mobilization, drawing from the experience of two interventions in Zambian children with nutritionally enhanced, biofortified orange maize conducted by the National Food and Nutrition Commission and Tropical Diseases Research Center (Zambia), and University of Wisconsin-Madison (USA). The preparatory phase included site visits, signing of a Memorandum of Understanding, equipment inventory, hiring staff, and community meetings. Prior results were shared before the second intervention. After Institutional Review Boards' approval of procedures, written informed consent was obtained from caregivers. There was overwhelming community participation attributed to the demystification that the project was run by satanists prior to and during the study. Participation led to excellent compliance with 92.8 and 96.4% of subjects completing the final blood draw in 2010 and 2012, respectively. The results of the trials were successfully shared with the district officials and communities from where the study participants were drawn. The positive response by partners and communities, including information sharing, suggests that community mobilization, with the use of varied methods, is effective for full participation of the target groups in feeding trials and would be the case in similar trials if effectively carried out. Community participation in research studies may result in long-term adoption of biofortified foods.
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Affiliation(s)
| | | | | | - Cassim Masi
- National Food and Nutrition Commission, Lusaka, Zambia
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Chopra M, Bhutta Z, Chang Blanc D, Checchi F, Gupta A, Lemango ET, Levine OS, Lyimo D, Nandy R, O'Brien KL, Okwo-Bele JM, Rees H, Soepardi J, Tolhurst R, Victora CG. Addressing the persistent inequities in immunization coverage. Bull World Health Organ 2019; 98:146-148. [PMID: 32015586 PMCID: PMC6986232 DOI: 10.2471/blt.19.241620] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Mickey Chopra
- World Bank, 1776 G St NW, Washington, DC, 20006, United States of America (USA)
| | | | - Diana Chang Blanc
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Francesco Checchi
- Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, England
| | | | - Ephrem T Lemango
- International Institute for Primary Health Care, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Dafrossa Lyimo
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Robin Nandy
- Health Section, United Nations Children's Fund, New York, USA
| | - Katherine L O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Helen Rees
- Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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Salam RA, Das JK, Bhutta ZA. Integrating nutrition into health systems: What the evidence advocates. MATERNAL & CHILD NUTRITION 2019; 15 Suppl 1:e12738. [PMID: 30748112 PMCID: PMC6594109 DOI: 10.1111/mcn.12738] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 12/02/2022]
Abstract
There is considerable evidence of positive health and nutrition outcomes resulting from integrating nutrition-specific interventions into health systems; however, current knowledge on establishing and sustaining effective integration of nutrition into health systems is limited. The objective of this review is to map the existing types of integration platforms and review the evidence on integrated health and nutrition programmes' impacts on specific nutrition outcomes. A literature search was conducted, and integrated nutrition programmes were examined through the lens of the six World Health Organization (WHO) building blocks, including the demand side. Forty-five studies were included in this review, outlining the integration of nutrition-specific interventions with various programmes, including integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with no adverse effects on primary programme delivery. Through the lens of the six WHO building blocks, service delivery and health workforce were found to be well-integrated, but governance, information systems, finance and supplies and technology were less well-integrated. Integrating nutrition-specific interventions into health systems may ensure efficient service delivery while having an impact on nutrition outcomes. There is no single successful model of integration; it varies according to the context and demands of the particular setting in which integration occurs. There is a need for more well-planned programmes considering all the health systems building blocks to ensure compliance and sustainability.
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Affiliation(s)
- Rehana A. Salam
- Division of Woman and Child HealthThe Aga Khan UniversityKarachiPakistan
- South Australian Health and Medical Research Institute; and University of AdelaideAdelaideAustralia
| | - Jai K. Das
- Division of Woman and Child HealthThe Aga Khan UniversityKarachiPakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoOntarioCanada
- Centre of Excellence in Women and Child HealthThe Aga Khan UniversityKarachiPakistan
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Gyorkos TW, Montresor A, Belizario V, Biggs BA, Bradley M, Brooker SJ, Casapia M, Cooper P, Deb S, Gilbert NL, Imtiaz R, Khieu V, Knopp S, Lincetto O, Mofid LS, Mupfasoni D, Vail C, Vercruysse J. The right to deworming: The case for girls and women of reproductive age. PLoS Negl Trop Dis 2018; 12:e0006740. [PMID: 30462641 PMCID: PMC6248892 DOI: 10.1371/journal.pntd.0006740] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Theresa W. Gyorkos
- World Health Organization Collaborating Centre for Research and Training in Parasite Epidemiology and Control, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- * E-mail:
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Vicente Belizario
- Department of Parasitology, College of Public Health, University of the Philippines-Manila, Philippines
| | - Beverley-Ann Biggs
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | | | - Simon J. Brooker
- Neglected Tropical Diseases-Global Health, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Martin Casapia
- Ciencias Médicas y de la Salud, Universidad Nacional de la Amazonia Peruana and Asociación Civil Selva Amazónica, Iquitos, Peru
| | - Philip Cooper
- Department of Epidemiology of Infectious Diseases, St. George’s, University of London, London, United Kingdom
| | - Sila Deb
- Child Health, Ministry of Health and Family Welfare, New Delhi, India
| | - Nicolas L. Gilbert
- World Health Organization Collaborating Centre for Research and Training in Parasite Epidemiology and Control, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Quebec, Canada
| | - Rubina Imtiaz
- Children Without Worms, Atlanta, Georgia, United States of America
| | - Virak Khieu
- National Helminth Control Programme, National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Stefanie Knopp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institution and University of Basel, Basel, Switzerland
| | - Ornella Lincetto
- Family, Women’s and Children’s Health, Maternal, Newborn, Child and Adolescent Health, Policy, Planning and Programmes, World Health Organization, Geneva, Switzerland
| | - Layla S. Mofid
- World Health Organization Collaborating Centre for Research and Training in Parasite Epidemiology and Control, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Quebec, Canada
| | - Denise Mupfasoni
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Cori Vail
- STH Global Public Health, Johnson and Johnson, Raritan, New Jersey, United States of America
| | - Jozef Vercruysse
- Department of Virology, Parasitology, and Immunology, Ghent University, Merelbeke, Belgium
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Perry HB, Sacks E, Schleiff M, Kumapley R, Gupta S, Rassekh BM, Freeman PA. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects. J Glob Health 2018; 7:010906. [PMID: 28685044 PMCID: PMC5491945 DOI: 10.7189/jogh.07.010906] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As part of our review of the evidence of the effectiveness of community-based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH), we summarize here the common delivery strategies of projects, programs and field research studies (collectively referred to as projects) that have demonstrated effectiveness in improving child mortality. Other articles in this series address specifically the effects of CBPHC on improving MNCH, while this paper explores the specific strategies used. METHODS We screened 12 166 published reports in PubMed of community-based approaches to improving maternal, neonatal and child health in high-mortality, resource-constrained settings from 1950-2015. A total of 700 assessments, including 148 reports from other publicly available sources (mostly unpublished evaluation reports and books) met the criteria for inclusion and were reviewed using a data extraction form. Here we identify and categorize key strategies used in project implementation. RESULTS Six categories of strategies for program implementation were identified, all of which required working in partnership with communities and health systems: (a) program design and evaluation, (b) community collaboration, (c) education for community-level staff, volunteers, beneficiaries and community members, (d) health systems strengthening, (e) use of community-level workers, and (f) intervention delivery. Four specific strategies for intervention delivery were identified: (a) recognition, referral, and (when possible) treatment of serious childhood illness by mothers and/or trained community agents, (b) routine systematic visitation of all homes, (c) facilitator-led participatory women's groups, and (d) health service provision at outreach sites by mobile health teams. CONCLUSIONS The strategies identified here provide useful starting points for program design in strengthening the effectiveness of CBPHC for improving MNCH.
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Affiliation(s)
- Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meike Schleiff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Paul A Freeman
- Independent consultant, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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17
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Deardorff KV, Rubin Means A, Ásbjörnsdóttir KH, Walson J. Strategies to improve treatment coverage in community-based public health programs: A systematic review of the literature. PLoS Negl Trop Dis 2018; 12:e0006211. [PMID: 29420534 PMCID: PMC5805161 DOI: 10.1371/journal.pntd.0006211] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022] Open
Abstract
Background Community-based public health campaigns, such as those used in mass deworming, vitamin A supplementation and child immunization programs, provide key healthcare interventions to targeted populations at scale. However, these programs often fall short of established coverage targets. The purpose of this systematic review was to evaluate the impact of strategies used to increase treatment coverage in community-based public health campaigns. Methodology/ principal findings We systematically searched CAB Direct, Embase, and PubMed archives for studies utilizing specific interventions to increase coverage of community-based distribution of drugs, vaccines, or other public health services. We identified 5,637 articles, from which 79 full texts were evaluated according to pre-defined inclusion and exclusion criteria. Twenty-eight articles met inclusion criteria and data were abstracted regarding strategy-specific changes in coverage from these sources. Strategies used to increase coverage included community-directed treatment (n = 6, pooled percent change in coverage: +26.2%), distributor incentives (n = 2, +25.3%), distribution along kinship networks (n = 1, +24.5%), intensified information, education, and communication activities (n = 8, +21.6%), fixed-point delivery (n = 1, +21.4%), door-to-door delivery (n = 1, +14.0%), integrated service distribution (n = 9, +12.7%), conversion from school- to community-based delivery (n = 3, +11.9%), and management by a non-governmental organization (n = 1, +5.8%). Conclusions/significance Strategies that target improving community member ownership of distribution appear to have a large impact on increasing treatment coverage. However, all strategies used to increase coverage successfully did so. These results may be useful to National Ministries, programs, and implementing partners in optimizing treatment coverage in community-based public health programs. Many public health platforms provide decentralized interventions outside of health facilities, including mass drug administration for neglected tropical diseases, immunizations, vitamin supplementation, and others. The purpose of these community-based public health platforms is to reach large proportions of populations in need with important preventative healthcare. However the platforms require high treatment coverage of targeted populations in order to achieve health impact. And, in many cases, targeted populations are low-income, rural, and hard to reach with large health campaigns. The purpose of this systematic review is to evaluate strategies for achieving high treatment coverage in public health service distribution programs. We identified nine different strategies used to increase coverage of distribution programs. Community-directed distribution was associated with the largest increase in treatment coverage. Similarly, incentivizing distributors also had a strong influence on increasing treatment coverage. These findings have important implications for governments, implementers, and funders who aim to provide health services at scale.
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Affiliation(s)
- Katrina V. Deardorff
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- DeWorm3, Natural History Museum, London, United Kingdom
| | - Kristjana H. Ásbjörnsdóttir
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- DeWorm3, Natural History Museum, London, United Kingdom
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- DeWorm3, Natural History Museum, London, United Kingdom
- Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, United States of America
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18
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Kipp AM, Maimbolwa M, Brault MA, Kalesha-Masumbu P, Katepa-Bwalya M, Habimana P, Vermund SH, Mwinga K, Haley CA. Improving access to child health services at the community level in Zambia: a country case study on progress in child survival, 2000-2013. Health Policy Plan 2017; 32:603-612. [PMID: 28453711 PMCID: PMC5964895 DOI: 10.1093/heapol/czw141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2016] [Indexed: 11/17/2022] Open
Abstract
Reductions in under-five mortality in Africa have not been sufficient to meet the Millennium Development Goal #4 (MDG#4) of reducing under-five mortality by two-thirds by 2015. Nevertheless, 12 African countries have met MDG#4. We undertook a four country study to examine barriers and facilitators of child survival prior to 2015, seeking to better understand variability in success across countries. The current analysis presents indicator, national document, and qualitative data from key informants and community women describing the factors that have enabled Zambia to successfully reduce under-five mortality over the last 15 years and achieve MDG#4. Results identified a Zambian national commitment to ongoing reform of national health strategic plans and efforts to ensure universal access to effective maternal, neonatal and child health (MNCH) interventions, creating an environment that has promoted child health. Zambia has also focused on bringing health services as close to the family as possible through specific community health strategies. This includes actively involving community health workers to provide health education, basic MNCH services, and linking women to health facilities, while supplementing community and health facility work with twice-yearly Child Health Weeks. External partners have contributed greatly to Zambia’s MNCH services, and their relationships with the government are generally positive. As government funding increases to sustain MNCH services, national health strategies/plans are being used to specify how partners can fill gaps in resources. Zambia’s continuing MNCH challenges include basic transportation, access-to-care, workforce shortages, and financing limitations. We highlight policies, programs, and implementation that facilitated reductions in under-five mortality in Zambia. These findings may inform how other countries in the African Region can increase progress in child survival in the post-MDG period.
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Affiliation(s)
- Aaron M Kipp
- Vanderbilt Institute for Global Health.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Marie A Brault
- Department of Anthropology, University of Connecticut, Storrs, CT, USA
| | | | | | - Phanuel Habimana
- World Health Organization/Regional Office for Africa, Brazzaville, Congo
| | - Sten H Vermund
- Vanderbilt Institute for Global Health.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kasonde Mwinga
- World Health Organization/Regional Office for Africa, Brazzaville, Congo
| | - Connie A Haley
- Vanderbilt Institute for Global Health.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Jefferds MED, Mirkovic KR, Subedi GR, Mebrahtu S, Dahal P, Perrine CG. Predictors of micronutrient powder sachet coverage in Nepal. MATERNAL AND CHILD NUTRITION 2016; 11 Suppl 4:77-89. [PMID: 26332845 DOI: 10.1111/mcn.12214] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many countries implement micronutrient powder (MNP) programmes to improve the nutritional status of young children. Little is known about the predictors of MNP coverage for different delivery models. We describe MNP coverage of an infant and young child feeding and MNP intervention for children aged 6-23 months comparing two delivery models piloted in rural Nepal: distributing MNPs either by female community health volunteers (FCHVs) or at health facilities (HFs). Cross-sectional household cluster surveys were conducted in four pilot districts among mothers of children 6-23 months after starting MNP distribution. FCHVs in each cluster were also surveyed. We used logistic regression to describe predictors of initial coverage (obtaining a batch of 60 MNP sachets) at 3 months and repeat coverage (≥2 times coverage among eligible children) at 15 months after project launch. At 15 months, initial and repeat coverage were higher in the FCHV model, although no differences were observed at 3 months. Attending an FCHV-led mothers' group meeting where MNP was discussed increased odds of any coverage in both models at 3 months and of repeat coverage in the HF model at 15 months. Perceiving ≥1 positive effects in the child increased odds of repeat coverage in both delivery models. A greater portion of FCHV volunteers from the FCHV model vs. the HF model reported increased burden at 3 and 15 months (not statistically significant). Designing MNP programmes that maximise coverage without overburdening the system can be challenging and more than one delivery model may be needed.
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Affiliation(s)
- Maria Elena D Jefferds
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Kelsey R Mirkovic
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Giri Raj Subedi
- Child Health Division, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | - Cria G Perrine
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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20
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Chamla D, Luo C, Adjorlolo-Johnson G, Vandelaer J, Young M, Costales MO, McClure C. Integration of HIV infant testing into immunization programmes: a systematic review. Paediatr Int Child Health 2016; 35:298-304. [PMID: 26744153 DOI: 10.1080/20469047.2015.1109233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Integration of HIV infant testing into immunization sessions is one of the strategies designed to increase coverage of early infant diagnosis. OBJECTIVE To determine the evidence on the outcomes of such integration. METHODS A systematic review of peer-reviewed and grey literature was undertaken from electronic sources such as MEDLINE, Google Scholar, websites of international agencies, past conferences and ministries of health reports published between year 2002 and 2013. Randomized controlled trials, observational and qualitative studies were searched and those meeting selection criteria were selected and relevant information extracted using structured tool. Statistical pooling was not possible owing to the heterogeneity of the study designs and outcome measures. RESULTS Of the nine articles which met the selection criteria, none used a randomized controlled design. Of these, five articles measured mother's acceptability of their infants being tested for HIV during its first pentavalent or DPT vaccination visit, and 89·5-100% accepted. Four articles reported the proportion of mothers who returned for HIV test results, ranging from 56·8% to 86·0%. Increased uptake of HIV testing following integration was confirmed by two articles. Only one study in Tanzania determined the uptake of vaccinations following integration, with urban facilities showing stable or slight increase of monthly vaccine uptake while decreases were observed across the rural sites. In two articles, stigma was perceived by service-providers and mothers as the potential risk following integration, particularly in rural settings. DISCUSSION Despite the limited number of articles, the findings in this systematic review suggest that HIV testing during immunization clinic visits is acceptable and feasible as a possible model for service delivery. However, the impact on vaccination uptake needs further study.
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21
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Delivering essential nutrition services for children after the Nepal earthquake. LANCET GLOBAL HEALTH 2016; 3:e665-6. [PMID: 26475006 DOI: 10.1016/s2214-109x(15)00184-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/19/2015] [Indexed: 11/20/2022]
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Kupka R, Nielsen J, Nyhus Dhillon C, Blankenship J, Haskell MJ, Baker SK, Brown KH. Safety and Mortality Benefits of Delivering Vitamin A Supplementation at 6 Months of Age in Sub-Saharan Africa. Food Nutr Bull 2016; 37:375-386. [DOI: 10.1177/0379572116646280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Vitamin A supplementation (VAS) among children 6 to 59 months of age reduces vitamin A deficiency (VAD)-related mortality. Child health days (CHDs) only reach an estimated 16.7% of children at exactly 6 months, leaving uncovered children at risk of VAD-related mortality; similarly, VAS provided at 9 months of age with measles-containing vaccine leaves infants unprotected for 3 months. Objective: Using data from sub-Saharan Africa, we estimated the mortality benefits and safety of providing VAS at age 6 months, compared to delivery through CHDs and at 9 months. Methods: We modeled VAS-preventable mortality benefits at 6 months as a function of published VAS effect sizes, intervention coverage, and proportion of infant deaths occurring between 6 and 11 months. To evaluate safety, we modeled the effect of different VAS coverage scenarios on maximum hepatic vitamin A concentrations (HVACs). Results: VAS linked to a 6-month visit could reduce infant mortality by an additional 1.95 (95% confidence interval [CI]: 1.38-2.52) and 1.63 (95% CI: 1.15-2.11) percentage points compared to VAS through CHDs and at 9 months, respectively. The HVAC models indicate that VAS at 6 months is safe even in the presence of a second VAS dose 1 month later and other food-based vitamin A control strategies. Conclusion: Advancing the first VAS dose to 6 months should be considered in settings where VAS is currently given first at 9 months. A 6-month VAS dose should also be considered in settings where VAS is delivered through CHDs. VAS delivery at 6 months could also serve as a platform to deliver other high-impact interventions.
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Affiliation(s)
| | | | | | | | - Marjorie J. Haskell
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Shawn K. Baker
- Helen Keller International Africa Regional Office, Dakar, Senegal
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Kenneth H. Brown
- Helen Keller International Africa Regional Office, Dakar, Senegal
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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Klemm RDW, Palmer AC, Greig A, Engle-Stone R, Dalmiya N. A Changing Landscape for Vitamin A Programs: Implications for Optimal Intervention Packages, Program Monitoring, and Safety. Food Nutr Bull 2016; 37:S75-86. [PMID: 27004480 DOI: 10.1177/0379572116630481] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vitamin A deficiency (VAD) remains a widespread public health problem in the developing world, despite changes in under-5 mortality rates, morbidity patterns, and intervention options. OBJECTIVE This article considers the implications of a changing epidemiologic and programmatic landscape for vitamin A (VA) programs. METHODS We review progress to prevent VAD and its health consequences, assess gaps in VA status and intervention coverage data, and assess data needed to guide decisions regarding the optimal mix, targeting, and dose of VA interventions to maximize benefit and minimize risk. RESULTS Vitamin A supplementation programs have contributed to the reduction in under-5 mortality rates, but alone, do not address the underlying problem of inadequate dietary VA intakes and VAD among preschool-aged children in the developing world. A combination of VA interventions (eg, supplementation, fortified foods, multiple micronutrient powders, and lipid-based nutrient supplements) will be required to achieve VA adequacy in most settings. Current efforts to measure the coverage of multiple VA interventions, as well as whether and how much VA children are receiving, are few and fragmented. CONCLUSIONS Where intervention overlap exists, further effort is needed to monitor VA intakes, ensuring that targeted groups are consuming adequate amounts but not exceeding the tolerable upper intake level. Vitamin A status data will also be critical for navigating the changing landscape of VA programs. Data from these monitoring efforts will help to guide decisions on the optimal mix, targeting, and exposure to VA interventions to maximize public health benefit while minimizing any potential risk.
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Affiliation(s)
- Rolf D W Klemm
- Helen Keller International, New York, NY, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda C Palmer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison Greig
- Micronutrient Initiative, Ottawa, Ontario, Canada
| | | | - Nita Dalmiya
- UNICEF, West and Central Africa Regional Office, Dakar, Senegal, Africa
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Kumapley RS, Kupka R, Dalmiya N. The Role of Child Health Days in the Attainment of Global Deworming Coverage Targets among Preschool-Age Children. PLoS Negl Trop Dis 2015; 9:e0004206. [PMID: 26544550 PMCID: PMC4636308 DOI: 10.1371/journal.pntd.0004206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background Global deworming programs aim to reach 75% of at-risk preschool-age children (pre-SAC) by 2020. The 2013 global pre-SAC deworming coverage initially published by the World Health Organization (WHO) was 23.9%, but this estimate inadequately captured deworming delivered through Child Health Day (CHD) platforms. Objective To update global and regional coverage estimates of pre-SAC deworming in 2013 by supplementing data from the WHO Preventive Chemotherapy and Transmission Control (PCT) databank with national CHD data. Methods UNICEF country offices (n = 82) were mailed a questionnaire in July 2014 to report on official national biannual CHD deworming coverage as part of the global vitamin A supplementation coverage reporting mechanism. Coverage data obtained were validated and considered for inclusion in the PCT databank in a collaboration between UNICEF and WHO. Descriptive statistical analyses were conducted to update the number of pre-SAC reached and the number of treatments delivered. Results Of the 47 countries that responded to the UNICEF pre-SAC deworming questionnaire, 73 data points from 39 countries were considered for inclusion into the WHO PCT databank. Of these, 21 new data points were from 12 countries were newly integrated into the WHO database. With this integration, deworming coverage among pre-SAC increased to 49.1%, representing an increase in the number of children reached and treatments administered from 63.7 million to 130.7 million and 94.7 million to 234.8 million, respectively. The updated databank comprised 98 mass deworming activities conducted in 55 countries, in which 80.4% of the global pre-SAC population requiring deworming reside. In all, 57 countries requiring deworming were not yet represented in the database. Conclusions With the inclusion of CHD data, global deworming programs are on track to achieving global pre-SAC coverage targets. However, further efforts are needed to improve pre-SAC coverage reporting as well as to sustain and expand deworming delivery through CHDs and other platforms. Soil-transmitted helminthiases are a group of parasitic diseases caused by intestinal worms that are linked to poor physical and cognitive development among preschool aged children. The administration of deworming drugs designed to reduce the intensity of the worm infection in the child is effective and efficient intervention to control the disease and has set the goal of deworming 75% of at-risk children by 2020. However, global WHO-reported coverage decreased from 37.1% to 24.7% from 2010 to 2012. In 2013, the first coverage estimate released was 23.9%, but as in previous years, this estimate did not adequately capture coverage achieved through Child Health Days, which are integrated campaign-style events where deworming is often co-delivered alongside vitamin A supplementation and other high impact child interventions. In this paper, we mailed a questionnaire to UNICEF country offices requesting data pertaining to preschool age deworming conducted through Child Health Days. After reviewing submissions and integrating data into the global databank, we report that the global coverage now stands at 49.4% putting us on track to achieve the global goal by 2020. The sharp increase in coverage illustrates the importance of Child Health Days for attaining global pre-SAC coverage goals.
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Affiliation(s)
- Richard Senam Kumapley
- Micronutrients Unit, Nutrition Section, UNICEF Headquarters, New York, New York, United States of America
| | - Roland Kupka
- Micronutrients Unit, Nutrition Section, UNICEF Headquarters, New York, New York, United States of America
- * E-mail:
| | - Nita Dalmiya
- Nutrition Section, UNICEF Regional Office for West and Central Africa, Dakar, Senegal
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Micronutrient powder distribution through Maternal, Neonatal and Child Health Weeks in Nigeria: process evaluation of feasibility and use. Public Health Nutr 2015; 19:1882-92. [PMID: 26370070 DOI: 10.1017/s1368980015002499] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the feasibility of distributing micronutrient powders (MNP) for home fortification during biannual Maternal, Neonatal and Child Health Week (MNCHW) events, as a strategy to improve young child nutrition. DESIGN We evaluated the coverage, delivery, use and adherence of MNP, and associated behaviour change communication (BCC) materials and social mobilization, through cross-sectional surveys of caregivers attending health-service distribution events and health workers involved in MNP distribution, facility-based observations of MNP distribution activities and a repeated survey of caregivers in their homes who received MNP for their child. SETTING Four Local Government Areas in Benue State, Nigeria. SUBJECTS Caregivers of children 6-59 months of age attending health-service distribution events. RESULTS The 8 million MNP delivered in this pilot during three distribution events were estimated to reach about one-third of eligible children in the area at each event. Programme fidelity was limited by shortages of MNP, BCC materials and inadequate social mobilization, with some limitations in health worker training and engagement. MNP use was consistent with the recommended two or three sachets per week among 51-69 % of caregivers surveyed at home. CONCLUSIONS MNP coverage was low, but consistent with that typically achieved with other services delivered through MNCHW in Benue. Among caregivers who received MNP, acceptance and use among targeted children was high. While some weaknesses in knowledge and delivery of MNP by health workers were observed, health system strengthening and more extensive social mobilization would be key to achieving higher coverage with MNP and other health services provided through MNCHW.
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Fiedler JL, Semakula R. An Analysis of the Costs of Uganda's Child Days Plus: Do Low Costs Reveal an Efficient Program or an Underfinanced One? Food Nutr Bull 2014; 35:92-104. [DOI: 10.1177/156482651403500111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Twice annually, Uganda implements Child Days Plus (CDP), a month-long outreach activity that distributes vitamin A capsules to preschool children and deworms children 6 months to 14 years old. Introduced initially as a temporary, interim strategy, CDP is now a decade old. Objective To assess how well CDP is implemented using an activity-based cost analysis. Methods In the absence of a cost-accounting system for CDP, we defined the six major CDP activities as cost centers and identified five important subactivities required to implement a round of CDP. Based on a purposive sample, we conducted a structured interview survey of 59 Ministry of Health facilities, 9 district offices, and national-level CDP staff. Results Only one-third of the facilities implemented all 11 CDP core activities. The survey revealed that Ministry of Health staff and volunteers are frequently paid substantially less in allowances than they are entitled to for their CDP outreach activities. Viewing these two practices—nonimplementation and less-than-full-reimbursement—as indicators of CDP's underfinancing, we estimate the program is underfinanced by the equivalent of 37% of its “full implementation” costs. Two-thirds of underfinancing is manifested in nonimplementation and one-third as less-than full-reimbursement. CDP exploits economies of scale and scope and has an average cost per child served of US$0.22. We estimate that it annually saves 367,000 disability-adjusted life-years (DALYs) at an average cost of US$12.5, making it—despite its underfinancing—highly cost-effective. Conclusions and recommendations Increased CDP funding would enable its vitamin A coverage rate of 58% and its deworming coverage rate of 62% to be increased, thereby increasing its effectiveness and efficiency. CDP should be “relaunched,” as part of an effort to improve the structure of the program, set expectations about it, and earmark a minimum of resources for CDP. The Ministry of Health should demonstrate its new, greater commitment to CDP by introducing a program-specific budget line item, increasing CDP's budget allocation, and developing and implementing a training program that identifies the minimum uniform activities required to implement CDP.
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