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Glozah FN, Tabong PTN, Bazant E, Asampong E, Hornuvo R, Nwameme A, Peprah NY, Chandi GM, Adongo PB, Dako-Gyeke P. Implementation and effectiveness outcomes of Community Health Advocacy Teams to improve long-lasting insecticide net distribution and use in six districts in Ghana: A one-group pre-post-test study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002123. [PMID: 38557578 PMCID: PMC10984411 DOI: 10.1371/journal.pgph.0002123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Malaria remains a leading cause of illness and death especially among children and pregnant women in Ghana. Despite the efforts made by the National Malaria Elimination Programme (NMEP), including distribution of Long-Lasting Insecticide Nets (LLINs) to households through periodic Point Mass Distribution (PMD) campaigns and continuous channels (antenatal, schools and postnatal), there is a gap between access and use of LLINs in Ghana. An effective and functional community-based group that would seek to improve the effectiveness of LLIN distribution before, during, after PMD Campaigns and continuous distribution at the community level could help address this gap. This paper assesses the implementation outcomes and short-term effectiveness of the pilot implementation of co-created community health advocacy teams (CHAT) intervention in Ghanaian communities to plan and implement campaigns to increase LLIN use. The study employed a one-group pre-post study design and measured implementation outcomes (acceptability, appropriateness, and feasibility) and effectiveness outcomes (LLIN awareness, LLIN access, willingness to purchase LLIN, and LLIN use) among 800 community households. The CHAT intervention was implemented for four months across six districts in the Eastern and Volta regions of Ghana. The data were downloaded directly from REDCap and analyzed statistically (descriptive and McNemar test of association) using SPSS 22 software. After the implementation period, the majority of respondents in all six districts indicated that the CHAT intervention was acceptable (89.8%), appropriate (89.5%), and feasible (90%). Also, there was a significant association between baseline and end-line assessment on all four effectiveness outcome measures. Household members' awareness of, access to, willingness to purchase, and use of LLINs increased significantly over the four-month period that the CHAT intervention was implemented. The study concludes that CHAT is an acceptable, appropriate, and feasible intervention for supporting the National Malaria Programme in LLIN PMD and for engaging in Social and Behaviour Change Communication activities through the continuous channels of distribution. Additionally, the CHAT demonstrates short-term effectiveness outcomes in terms of creating LLIN awareness, providing access to LLIN, and encouraging Ghanaian community members to be willing to purchase and use LLINs. Although the activities of CHAT members were largely voluntary, integration into the existing primary health care system will make it sustainable.
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Affiliation(s)
- Franklin N. Glozah
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Eva Bazant
- Health Campaign Effectiveness Coalition, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Emmanuel Asampong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Ruby Hornuvo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Gloria M. Chandi
- Ghana Health Service, Ga North Municipal Health Directorate, Greater Accra, Ghana
| | - Philip Baba Adongo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
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Deressa A, Gamachu M, Birhanu A, Mamo Ayana G, Raru TB, Negash B, Merga BT, Regassa LD, Ababulgu FA. Malaria Risk Perception and Preventive Behaviors Among Elementary School Students, Southwest Ethiopia. Generalized Structural Equation Model. Infect Drug Resist 2023; 16:4579-4592. [PMID: 37465183 PMCID: PMC10351682 DOI: 10.2147/idr.s415376] [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: 04/27/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
Background In 2020, more than three billion of the world's population were the risk of being infected with malaria and four out of five deaths were from the African population. However, information is scarce on the association between risk perceptions and malaria prevention behaviors in resource-limited countries, particularly Ethiopia. Therefore, this study aimed to assess malaria risk perceptions and preventive behaviors. Methods A cross-sectional study design was conducted among 401 elementary school students in Jimma zone, Oromia, Ethiopia, from April 2 to June 8, 2020. Data were collected through interviews using a semi-structured questionnaire. The data were entered into Epi-data 4.6 and analyzed using STATA version 14.2. The descriptive statistics were presented using frequency and percentages. A Cronbach's α coefficient of 0.7 or higher was used to assess the reliability of each domain. The Generalized Structural Equation Model (GSEM) was employed to examine the relationships and prediction of explanatory variables with risk perception and preventive behaviors of malaria. The model with a lower information criterion was taken as a better-fitting model. Finally, the statistically significant model effects were declared at a P-value of less than 0.05 at a confidence interval of 95%. Results This study showed that having knowledge about malaria had an indirect positive effect on malaria preventive behavior (β = 1.29, 95% CI 0.11 to 2.47), and had a positive total effect on the preventive behavior (β = 2.99, 95% CI 0.08 to 2.67). Besides, an increased knowledge level had a direct positive effect on malaria risk perceptions (β = 0.08, 95% CI 0.01 to 0.14), and malaria risk perception had a direct positive effect on malaria preventive behavior (β = 1.21, 95% CI 0.10 to 2.31). Conclusion and Recommendation This study demonstrated that having knowledge about malaria had a direct and indirect association with malaria preventive behavior. An increased level of knowledge had a direct positive effect on malaria risk perceptions. Moreover, malaria risk perception had a direct positive effect on malaria preventive behavior. Therefore, malaria prevention-targeted interventions, behavior change, and knowledge enhancing communication should be enhanced or scaled up to contribute to prompt treatment and progress toward the elimination of malaria.
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Affiliation(s)
| | - Mulugeta Gamachu
- School of Medicine, CHMS, Haramaya University, Harar, Ethiopia
- Departments of Public Health, Rift Valley University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, CHMS, Haramaya University, Harar, Ethiopia
| | | | | | - Belay Negash
- School of Public Health, CHMS, Haramaya University, Harar, Ethiopia
| | | | | | - Fira Abamecha Ababulgu
- Department of Health, Behavior, and Society, Faculty of Public Health Institute of Health, Jimma University, Jimma, Ethiopia
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Tizifa TA, Gowelo S, Kabaghe AN, McCann RS, Malenga T, Nkhata RM, Kadama A, Chapeta Y, Takken W, Phiri KS, van Vugt M, van den Berg H, Manda-Taylor L. Community-based house improvement for malaria control in southern Malawi: Stakeholder perceptions, experiences, and acceptability. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000627. [PMID: 36962454 PMCID: PMC10021647 DOI: 10.1371/journal.pgph.0000627] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/23/2022] [Indexed: 11/18/2022]
Abstract
House improvement (HI) refers to the full screening or closing of openings such as windows, doors, and eaves, as well as the installation of ceilings, to reduce mosquito-human contact indoors. HI is a viable supplementary intervention that reduces malaria transmission further than the existing strategies alone. In Malawi, HI has not been widely implemented and evaluated for malaria control. Concerns about lack of local evidence, durability in different epidemiological and cultural settings, and the cost of large-scale implementation are among the reasons the strategy is not utilised in many low-income countries. This study assessed community perceptions, experiences, and acceptability of community-led HI in Chikwawa district, southern Malawi. This was a qualitative study where separate focus group discussions were conducted with members from the general community (n = 3); health animators (n = 3); and HI committee members (n = 3). In-depth interviews were conducted with community members (n = 20), and key-informant interviews were conducted with health surveillance assistants and chiefs (n = 23). All interviews were transcribed and coded before performing a thematic content analysis to identify the main themes. Coded data were analysed using Nvivo 12 Plus software. Study participants had a thorough understanding of HI. Participants expressed satisfaction with HI, and they reported enabling factors to HI acceptability, such as the reduction in malaria cases in their villages and the safety and effectiveness of HI use. Participants also reported barriers to effective HI implementation, such as the unavailability and inaccessibility of some HI materials, as well as excessive heat and darkness in HI houses compared to non-HI houses. Participants indicated that they were willing to sustain the intervention but expressed the need for strategies to address barriers to ensure the effectiveness of HI. Our results showed the high knowledge and acceptability of HI by participants in the study area. Intensive and continued health education and community engagement on the significance of HI could help overcome the barriers and improve the acceptability and sustainability of the intervention.
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Affiliation(s)
- Tinashe A. Tizifa
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Steven Gowelo
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Alinune N. Kabaghe
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Robert S. McCann
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- Centre for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Tumaini Malenga
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- African Institute for Development Policy, Lilongwe, Malawi
| | - Richard M. Nkhata
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Asante Kadama
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Yankho Chapeta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Kamija S. Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michele van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Lucinda Manda-Taylor
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Espinoza JC, Chin SW, Shah P, Tut M, Raymond JK. Proposing a Practical, Simplified Framework for Implementing Integrated Diabetes Data and Technology Solutions. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:867284. [PMID: 36992736 PMCID: PMC10012144 DOI: 10.3389/fcdhc.2022.867284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022]
Abstract
Diabetes is a uniquely quantifiable disease, and as technology and data have proliferated over the past two decades, so have the tools to manage diabetes. Patients and providers have at their disposal devices, applications, and data platforms that generate immense amounts of data, provide critical insights into a patient’s disease, and allow for personalization of treatment plans. However, the proliferation of options also comes with new burdens for providers: selecting the right tool, getting buy-in from leadership, defining the business case, implementation, and maintenance of the new technology. The complexity of these steps can be overwhelming and sometimes lead to inaction, depriving providers and patients of the advantages of technology-assisted diabetes care. Conceptually, the adoption of digital health solutions can be thought of as occurring in five interconnected phases: Needs Assessment, Solution Identification, Integration, Implementation, and Evaluation. There are a number of existing frameworks to help guide much of this process, but relatively little attention has been focused on integration. Integration is a critical phase for a number of contractual, compliance, financial, and technical processes. Missing a step or doing them out of order can lead to significant delays and potentially wasted resources. To address this gap, we have developed a practical, simplified framework for integrating diabetes data and technology solutions that can guide clinicians and clinical leaders on the critical steps in adopting and implementing a new technology.
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Affiliation(s)
- Juan C. Espinoza
- Division of General Pediatrics, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Translational Informatics, Information Services Department, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Juan C. Espinoza,
| | - Steven W. Chin
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Payal Shah
- Division of General Pediatrics, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Maurice Tut
- Translational Informatics, Information Services Department, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Jennifer K. Raymond
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Endocrinology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, United States
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Acceptability of peer learning and education approach on malaria prevention (PLEA-malaria) through primary schools communities in rural Ethiopia: peer educators' perspectives. Malar J 2021; 20:437. [PMID: 34781945 PMCID: PMC8594237 DOI: 10.1186/s12936-021-03965-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence on peer educators' experiences of implementing the school-based educational interventions on malaria prevention would be used as inputs for malaria eliminating efforts. This study explored the acceptability of the school-based peer-learning and education approach on malaria prevention (PLEA-malaria) among peer educators in Ethiopia. METHODS This process evaluation study was aimed to examine the success of the school-based PLEA-malaria that was implemented in 75 primary schools in Jimma from 2017 to 2019. A mixed research method was employed to collect post-intervention data from 404 peer educators and key stakeholders. Data were collected using a structured questionnaire and interview guide. Multivariable linear regression modelling was performed using SPSS software version 26.0. Atlas ti 7.5 for windows was used to analyse the qualitative data. The result was presented by triangulating the findings of the qualitative and quantitative methods. RESULTS The mean score (M, range = R) of acceptability of PLEA-malaria was (M = 20.20, R = 6-30). The regression modelling showed that age; (β = 0.264, 95% CI 0.266 to 0.632), GPA; (β = 0.106, 95% CI 0.008 to 0.074), parental readiness for malaria education; (β = 0.184, 95% CI 0.711 to 2.130), frequency of peer education; (β = 0.232, 95% CI 1.087 to 2.514) and team spirit; (β = 0.141, 95% CI 0.027 to 0.177) were positively associated with the acceptability while this relationship was negative for the number of ITN in the household; (β = - 0.111, 95% CI - 1.182 to -0.13) and frequency of parent-student communication; (β = - 0.149, 95% CI - 1.201 to - 0.293). The qualitative study identified facilitators of PLEA-malaria (e.g. team formation process, outcome efficacy, presence of schools' structures, schools priority, and support) and barriers (e.g. low commitments, threat appraisal, response efficacy, and PLEA-malaria implementation gaps). CONCLUSION The results suggested that the acceptability of the school-based PLEA-malaria was higher implying the strategy is promising in promoting malaria prevention in primary schools. Considering factors related to personal, access to malaria preventive services, school system, and social support in education and behaviour change interventions would be important to improve the acceptability. The relationship about how an improvement in the level of acceptability would in turn influences malaria preventive behaviours among the students should be investigated.
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