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Truppa C, Alonso B, Clezy K, Deglise C, Dromer C, Garelli S, Jimenez C, Kanapathipillai R, Khalife M, Repetto E. Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now. Antimicrob Resist Infect Control 2023; 12:89. [PMID: 37667372 PMCID: PMC10476422 DOI: 10.1186/s13756-023-01301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
Fragile and conflict-affected settings bear a disproportionate burden of antimicrobial resistance, due to the compounding effects of weak health policies, disrupted medical supply chains, and lack of knowledge and awareness about antibiotic stewardship both among health care providers and health service users. Until now, humanitarian organizations intervening in these contexts have confronted the threat of complex multidrug resistant infections mainly in their surgical projects at the secondary and tertiary levels of care, but there has been limited focus on ensuring the implementation of adequate antimicrobial stewardship in primary health care, which is known to be setting where the highest proportion of antibiotics are prescribed. In this paper, we present the experience of two humanitarian organizations, Médecins sans Frontières and the International Committee of the Red Cross, in responding to antimicrobial resistance in their medical interventions, and we draw from their experience to formulate practical recommendations to include antimicrobial stewardship among the standards of primary health care service delivery in conflict settings. We believe that expanding the focus of humanitarian interventions in unstable and fragile contexts to include antimicrobial stewardship in primary care will strengthen the global response to antimicrobial resistance and will decrease its burden where it is posing the highest toll in terms of mortality.
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Affiliation(s)
- Claudia Truppa
- International Committee of the Red Cross, Geneva, Switzerland.
- CRIMEDIM Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, University of Eastern Piedmont, Novara, Italy.
| | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | - Carole Dromer
- International Committee of the Red Cross, Geneva, Switzerland
| | - Silvia Garelli
- International Committee of the Red Cross, Geneva, Switzerland
| | | | | | | | - Ernestina Repetto
- Médecins Sans Frontières, Geneva, Switzerland
- Service des Maladies Infectieuses, Clinique Hospitalière Universitaire Saint Pierre, Bruxelles, Belgium
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van den Ent MMVX, Swift RD, Anaokar S, Hegg LA, Eggers R, Cochi SL. Contribution of Global Polio Eradication Initiative-Funded Personnel to the Strengthening of Routine Immunization Programs in the 10 Focus Countries of the Polio Eradication and Endgame Strategic Plan. J Infect Dis 2017; 216:S244-S249. [PMID: 28838165 PMCID: PMC5853847 DOI: 10.1093/infdis/jiw567] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background. The Polio Eradication and Endgame Strategic Plan (PEESP) established a target that at least 50% of the time of personnel receiving funding from the Global Polio Eradication Initiative (GPEI) for polio eradication activities (hereafter, “GPEI-funded personnel”) should be dedicated to the strengthening of immunization systems. This article describes the self-reported profile of how GPEI-funded personnel allocate their time toward immunization goals and activities beyond those associated with polio, the training they have received to conduct tasks to strengthen routine immunization systems, and the type of tasks they have conducted. Methods. A survey of approximately 1000 field managers of frontline GPEI-funded personnel was conducted by Boston Consulting Group in the 10 focus countries of the PEESP during 2 phases, in 2013 and 2014, to determine time allocation among frontline staff. Country-specific reports on the training of GPEI-funded personnel were reviewed, and an analysis of the types of tasks that were reported was conducted. Results. A total of 467 managers responded to the survey. Forty-seven percent of the time (range, 23%–61%) of GPEI-funded personnel was dedicated to tasks related to strengthening immunization programs, other than polio eradication. Less time was spent on polio-associated activities in countries that had already interrupted wild poliovirus (WPV) transmission, compared with findings for WPV-endemic countries. All countries conducted periodic trainings of the GPEI-funded personnel. The types of non–polio-related tasks performed by GPEI-funded personnel varied among countries and included surveillance, microplanning, newborn registration and defaulter tracing, monitoring of routine immunization activities, and support of district immunization task teams, as well as promotion of health behaviors, such as clean-water use and good hygiene and sanitation practices. Conclusion. In all countries, GPEI-funded personnel perform critical tasks in the strengthening of routine immunization programs and the control of measles and rubella. In certain countries with very weak immunization systems, GPEI-funded personnel provide critical support for the immunization programs, and sudden discontinuation of their employment would potentially disrupt the immunization programs in their countries and create a setback in capacity and effectiveness that would put children at higher risk for vaccine-preventable diseases.
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Affiliation(s)
| | | | | | - Lea Anne Hegg
- Global Development, Bill and Melinda Gates Foundation, Seattle, Washington
| | - Rudolf Eggers
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Stephen L Cochi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Farra A, Gonofio EC, Manirakiza A, Mazitchi A, Mbaïlao R, Manengu C, Gouandjika-Vasilache I. Epidemiological Surveillance of Poliomyelitis During the Military and Political Conflict in the Central African Republic, 2013 and 2014. Open Forum Infect Dis 2017; 4:ofw279. [PMID: 28480271 PMCID: PMC5414109 DOI: 10.1093/ofid/ofw279] [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: 11/06/2016] [Accepted: 01/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since December 2012, the Central African Republic (CAR) has been undergoing a severe military and political conflict. This situation has resulted in general insecurity and total disorganization of surveillance activities, including those for acute flaccid paralysis (AFP). In this study, we used laboratory data to evaluate surveillance of AFP in 2013 and 2014, the most critical period of the conflict. METHODS The laboratory data on AFP were analyzed retrospectively for the age, sex, vaccination status (oral poliovirus vaccines), and geographical origin of the samples. The χ2 test was used, with P < .05 as the threshold for significance. RESULTS Decreased activity of AFP surveillance of 57% was registered in 2013 and 36% in 2014 compared with previous years. Only 37.3% and 49.7% of children with AFP were vaccinated in 2013 and 2014, respectively, but no wild poliovirus or vaccine-derived poliovirus (VDPV) was isolated. Laboratory performance concerning the timeliness of cell culture and intratypic differentiation/VDPV results was only 65.5% and 66.7% of the target in 2013 but reached 95.5% and 100% in 2014. CONCLUSIONS All personnel involved in the monitoring of AFP must be mobilized to improve vaccination coverage and surveillance activities in the CAR.
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Affiliation(s)
- Alain Farra
- Enteric Viruses and Measles Laboratory, Institut Pasteur de Bangui
| | - Ella C Gonofio
- Enteric Viruses and Measles Laboratory, Institut Pasteur de Bangui
| | | | - Arthur Mazitchi
- Enteric Viruses and Measles Laboratory, Institut Pasteur de Bangui
| | - Raphaël Mbaïlao
- Expanded Programme on Immunization, Ministry of Health, Bangui
| | - Casimir Manengu
- Focal Point for Immunization, Vaccines and Emergencies, World Health Organization, Bangui
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Closser S, Finley EP. A New Reflexivity: Why Anthropology Matters in Contemporary Health Research and Practice, and How to Make It Matter More. AMERICAN ANTHROPOLOGIST 2016. [DOI: 10.1111/aman.12532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Svea Closser
- Department of Sociology and Anthropology; Middlebury College; Middlebury Vermont United States
| | - Erin P. Finley
- Department of Psychiatry and Division of Hospital Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, and Veterans Evidence-based Research, Dissemination, and Implementation Center (VERDICT); South Texas Veterans Health Care System; San Antonio Texas United States
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Closser S, Rosenthal A, Maes K, Justice J, Cox K, Omidian PA, Mohammed IZ, Dukku AM, Koon AD, Nyirazinyoye L. The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative. Med Anthropol Q 2016; 30:321-41. [DOI: 10.1111/maq.12254] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Svea Closser
- Department of Sociology/Anthropology; Middlebury College
| | - Anat Rosenthal
- Department of Health Systems Management; Ben Gurion University of the Negev
| | - Kenneth Maes
- Department of Anthropology; Oregon State University
| | - Judith Justice
- Philip R. Lee Institute for Health Policy Studies; University of California at San Francisco
| | - Kelly Cox
- Department of Sociology/Anthropology; Middlebury College
| | | | | | | | - Adam D. Koon
- Department of Global Health and Development; London School of Hygiene and Tropical Medicine
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Klepac P, Funk S, Hollingsworth TD, Metcalf CJE, Hampson K. Six challenges in the eradication of infectious diseases. Epidemics 2014; 10:97-101. [PMID: 25843393 PMCID: PMC7612385 DOI: 10.1016/j.epidem.2014.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022] Open
Abstract
Eradication and elimination are increasingly a part of the global health agenda. Once control measures have driven infection to low levels, the ecology of disease may change posing challenges for eradication efforts. These challenges vary from identifying pockets of susceptibles, improving monitoring during and after the endgame, to quantifying the economics of disease eradication versus sustained control, all of which are shaped and influenced by processes of loss of immunity, susceptible build-up, emergence of resistance, population heterogeneities and non-compliance with control measures. Here we discuss how modelling can be used to address these challenges.
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Affiliation(s)
- Petra Klepac
- Department of Applied Mathematics and Theoretical Physics, Cambridge University, Cambridge, UK.
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - T Deirdre Hollingsworth
- Mathematics Institute and the School of Life Sciences, University of Warwick, UK; Liverpool School of Tropical Medicine, UK
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology and the Woodrow Wilson School, Princeton University, Princeton, NJ, USA
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, University of Glasgow, UK
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Closser S, Cox K, Parris TM, Landis RM, Justice J, Gopinath R, Maes K, Banteyerga Amaha H, Mohammed IZ, Dukku AM, Omidian PA, Varley E, Tedoff P, Koon AD, Nyirazinyoye L, Luck MA, Pont WF, Neergheen V, Rosenthal A, Nsubuga P, Thacker N, Jooma R, Nuttall E. The impact of polio eradication on routine immunization and primary health care: a mixed-methods study. J Infect Dis 2014; 210 Suppl 1:S504-13. [PMID: 24690667 PMCID: PMC4197907 DOI: 10.1093/infdis/jit232] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background. After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). Methods. Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. Results. Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. Conclusions. Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.
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Affiliation(s)
- Svea Closser
- Department of Sociology and Anthropology, Middlebury College, Middlebury
| | - Kelly Cox
- Department of Sociology and Anthropology, Middlebury College, Middlebury
| | | | | | - Judith Justice
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco
| | | | - Kenneth Maes
- Department of Anthropology, Oregon State University
| | | | | | | | | | - Emma Varley
- MNCH-RH Department, Health Services Academy, Islamabad
| | - Pauley Tedoff
- Department of Sociology and Anthropology, Middlebury College, Middlebury
| | - Adam D Koon
- Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom
| | | | | | | | - Vanessa Neergheen
- Department of Sociology and Anthropology, Middlebury College, Middlebury
| | - Anat Rosenthal
- Department of Biomedical Ethics, McGill University, Montreal, Canada
| | | | - Naveen Thacker
- Deep Children Hospital and Research Centre, Gandhidham, India
| | - Rashid Jooma
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Elizabeth Nuttall
- Department of Sociology and Anthropology, Middlebury College, Middlebury
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Mounier-Jack S, Griffiths UK, Closser S, Burchett H, Marchal B. Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework. BMC Public Health 2014; 14:278. [PMID: 24666579 PMCID: PMC3974593 DOI: 10.1186/1471-2458-14-278] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/12/2014] [Indexed: 02/05/2023] Open
Abstract
Background The WHO health systems Building Blocks framework has become ubiquitous in health systems research. However, it was not developed as a research instrument, but rather to facilitate investments of resources in health systems. In this paper, we reflect on the advantages and limitations of using the framework in applied research, as experienced in three empirical vaccine studies we have undertaken. Discussion We argue that while the Building Blocks framework is valuable because of its simplicity and ability to provide a common language for researchers, it is not suitable for analysing dynamic, complex and inter-linked systems impacts. In our three studies, we found that the mechanical segmentation of effects by the WHO building blocks, without recognition of their interactions, hindered the understanding of impacts on systems as a whole. Other important limitations were the artificial equal weight given to each building block and the challenge in capturing longer term effects and opportunity costs. Another criticism is not of the framework per se, but rather how it is typically used, with a focus on the six building blocks to the neglect of the dynamic process and outcome aspects of health systems. We believe the framework would be improved by making three amendments: integrating the missing “demand” component; incorporating an overarching, holistic health systems viewpoint and including scope for interactions between components. If researchers choose to use the Building Blocks framework, we recommend that it be adapted to the specific study question and context, with formative research and piloting conducted in order to inform this adaptation. Summary As with frameworks in general, the WHO Building Blocks framework is valuable because it creates a common language and shared understanding. However, for applied research, it falls short of what is needed to holistically evaluate the impact of specific interventions on health systems. We propose that if researchers use the framework, it should be adapted and made context-specific.
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Affiliation(s)
- Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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