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Duguay C, Niles-Robin RA, Thickstun CR, Cox H, Sampson A, Alexandre JSF, Caleb-Mars N, Goss CW, Morice A, Carvalho Scholte RG, Krentel A. Factors associated with never treatment and acceptability of mass drug administration for the elimination of lymphatic filariasis in Guyana, 2021. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001985. [PMID: 38662738 PMCID: PMC11045083 DOI: 10.1371/journal.pgph.0001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
Guyana remains one of four countries in the Americas endemic for lymphatic filariasis (LF). Elimination of LF requires repeated annual mass drug administration (MDA) with sufficient levels of coverage for success. This study assesses the acceptability and never treatment of LF MDA using data from a routine assessment survey in 2021. A subset of individuals, over 20 years of age (n = 2498), were selected to receive an expanded questionnaire to examine factors associated with acceptability and never treatment. Assessed factors include respondent demographics, knowledge, risk perceptions of LF, and opinions on the MDA programme. The majority (73%) of those with scores above the acceptability threshold (score ≥22.5) reported participating in MDA two or more times. Factors strongly and positively associated with scoring above the acceptability threshold include beliefs in importance of participation in MDA for their community (aOR = 2.8, 95%CI (1.1-7.2)), perception of importance of LF treatment (6.9 (3.2-14.7)), receiving treatment in 2021 (2.9 (1.5-5.4)), and the number of self-reported times taking treatment for LF (2.2 (1.1-4.4)). Ten percent of respondents participated in the MDA for the first time in 2021, while 15% reported never treatment during any round of LF MDA. Three factors were statistically associated with participation in MDA across the two levels of the models (level 1: took LF treatment once versus never, and level 2: took LF treatment twice versus never) included: 1) scoring above the acceptability threshold (aOR = 6.2, 95%CI(3.8-10.0)), 2) self-reported importance of participation in MDA for their community (7.1 (2.9-17.8)), and 3) personal beliefs that they should take LF treatment even if they are not sick (2.6 (1.7-3.9)). As Guyana moves closer to LF elimination, these results provide further insight and understanding into programmatic results and could inform further action following MDA activities-particularly if an approach is needed to address never treatment during MDA.
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Affiliation(s)
- Claudia Duguay
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Reza A. Niles-Robin
- Neglected Tropical Diseases Programme-Vector control Services, Ministry of Health, Georgetown, Guyana
| | - Charles R. Thickstun
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Horace Cox
- Neglected Tropical Diseases Programme-Vector control Services, Ministry of Health, Georgetown, Guyana
| | - Annastacia Sampson
- Neglected Tropical Diseases Programme-Vector control Services, Ministry of Health, Georgetown, Guyana
| | - Jean Seme-Fils Alexandre
- Neglected, Tropical, and Vector Borne Diseases, Pan American Health Organization, Washington, DC, United States of America
| | - Nathely Caleb-Mars
- Neglected, Tropical, and Vector Borne Diseases, Pan American Health Organization, Washington, DC, United States of America
| | - Charles W. Goss
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States of America
| | - Ana Morice
- Neglected, Tropical, and Vector Borne Diseases, Pan American Health Organization, Washington, DC, United States of America
| | - Ronaldo G. Carvalho Scholte
- Neglected, Tropical, and Vector Borne Diseases, Pan American Health Organization, Washington, DC, United States of America
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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Adhikari B, Bayo M, Peto TJ, Callery JJ, Tripura R, Dysoley L, Mshamu S, Gesase S, von Seidlein L, Dondorp AM. Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania. BMJ Glob Health 2023; 8:e013593. [PMID: 38070880 PMCID: PMC10729139 DOI: 10.1136/bmjgh-2023-013593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
The reduction of deaths from malaria in sub-Saharan Africa (SSA) is stalling, whereas many countries in Southeast Asia are approaching malaria elimination. We reviewed the role of community health worker (CHW) programmes in malaria control and elimination between regions, with a more detailed description of the programmes in Tanzania and Cambodia. Compared with Tanzania, Cambodia has a much more developed CHW network, which has been pivotal in the near elimination of malaria. In Tanzania, the malaria burden has remained similar over the last decade and treatment continues to rely on healthcare facilities, which provide more limited access to early diagnosis and treatment. Overall, the proportion of malaria cases treated by CHWs is substantially lower in SSA than in Southeast Asia. Even though networks of CHWs are resource intensive and malaria epidemiology differs substantially between countries, there is a strong case for expanding CHW networks in rural SSA to improve early access to effective malaria treatment and reduce the malaria burden.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Makhily Bayo
- Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - James J Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Lek Dysoley
- C.N.M National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Salum Mshamu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
- CSK Research Solutions, Mtwara, Tanzania
| | - Samwel Gesase
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
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Duthie MS, Roferos FO, Maghanoy AA, Balagon MF. Acceptability of rapid diagnostic tests among patients and their contacts in the Philippines is sustained beyond the completion of treatment. LEPROSY REV 2020. [DOI: 10.47276/lr.91.4.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chipukuma HM, Halwiindi H, Zulu JM, Azizi SC, Jacobs C. Evaluating fidelity of community health worker roles in malaria prevention and control programs in Livingstone District, Zambia-A bottleneck analysis. BMC Health Serv Res 2020; 20:612. [PMID: 32615960 PMCID: PMC7331272 DOI: 10.1186/s12913-020-05458-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/23/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Community Health Workers (CHWs) are an important human resource in improving community malaria intervention coverages and success in reducing malaria incidence has been attributed to them. However, despite this attribution, malaria resurgence cases have been reported in various countries including Zambia. This study aims to evaluate the implementation fidelity of CHW roles in malaria prevention and control programs in Livingstone through performance and service quality assessment. METHODS A mixed method concurrent cross-sectional study based on quantitative and qualitative approaches was used to evaluate performance and service quality of the CHW roles for selected catchments areas in Livingstone district. For the quantitative approach, (34) CHWs were interviewed and a community survey was also done with 464 community participants. For qualitative approach, two focused group discussions with CHWs and three key informant interviews from the CHW supervisors were done. RESULTS Overall implementation fidelity to the CHW roles was low with only 5(14.7%) of the CHWs having good performance and least good quality service while 29 (85.3%) performed poorly with substandard service. About 30% of house-holds reported having experienced malaria cases but CHWs had low coverage in testing with RDT (27%) for malaria index case service response with treatment at 14% coverage and provision of health education at 23%. For other households without malaria cases, only 27% had received malaria health education and 15% were screened for malaria. However, ITN distribution, sensitization for IRS were among other CHW services received by the community but were not documented in CHW registers for evaluation. Factors that shaped fidelity were being married, record for reports, supervision, and work experience as significant factors associated with performance. Lack of supplies, insufficient remuneration and lack of ownership by the supervising district were reported to hinder ideal implementation of the CHW strategy. CONCLUSION Fidelity to the malaria CHW roles was low as performance and quality of service was poor. A systems approach for malaria CHW facilitation considering supervision, stock supply and recruiting more CHWs on a more standardized level of recognition and remuneration would render an effective quality implementation of the CHW roles in malaria.
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Affiliation(s)
- Helen Mwiinga Chipukuma
- Department of Health Policy and Management, School of Public Health, University of Zambia, P. O. Box 50110, Lusaka, Zambia.
| | - Hikabasa Halwiindi
- Department of Environmental Health, School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Health promotion and Education, School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Steven Chifundo Azizi
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, P. O. Box 50110, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, P. O. Box 50110, Lusaka, Zambia
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Balanza N, Erice C, Ngai M, Varo R, Kain KC, Bassat Q. Host-Based Prognostic Biomarkers to Improve Risk Stratification and Outcome of Febrile Children in Low- and Middle-Income Countries. Front Pediatr 2020; 8:552083. [PMID: 33072673 PMCID: PMC7530621 DOI: 10.3389/fped.2020.552083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022] Open
Abstract
Fever is one of the leading causes for pediatric medical consultation and the most common symptom at clinical presentation in low- and middle-income countries (LMICs). Most febrile episodes are due to self-limited infections, but a small proportion of children will develop life-threatening infections. The early recognition of children who have or are progressing to a critical illness among all febrile cases is challenging, and there are currently no objective and quantitative tools to do so. This results in increased morbidity and mortality among children with impending life-threatening infections, whilst contributing to the unnecessary prescription of antibiotics, overwhelming health care facilities, and harm to patients receiving avoidable antimicrobial treatment. Specific fever origin is difficult to ascertain and co-infections in LMICs are common. However, many severe infections share common pathways of host injury irrespective of etiology, including immune and endothelial activation that contribute to the pathobiology of sepsis (i.e., pathogen "agnostic" mechanisms of disease). Importantly, mediators of these pathways are independent markers of disease severity and outcome. We propose that measuring circulating levels of these factors can provide quantitative and objective evidence to: enable early recognition of severe infection; guide patient triage and management; enhance post-discharge risk stratification and follow up; and mitigate potential gender bias in clinical decisions. Here, we review the clinical and biological evidence supporting the clinical utility of host immune and endothelial activation biomarkers as components of novel rapid triage tests, and discuss the challenges and needs for developing and implementing such tools.
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Affiliation(s)
- Núria Balanza
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Erice
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, ON, Canada.,Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle Ngai
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, ON, Canada.,Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rosauro Varo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Kevin C Kain
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, ON, Canada.,Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique.,ICREA, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Merritt MW, Sutherland CS, Tediosi F. Ethical Considerations for Global Health Decision-Making: Justice-Enhanced Cost-Effectiveness Analysis of New Technologies for Trypanosoma brucei gambiense. Public Health Ethics 2018; 11:275-292. [PMID: 30429873 PMCID: PMC6225893 DOI: 10.1093/phe/phy013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We sought to assess formally the extent to which different control and elimination strategies for human African trypanosomiasis Trypanosoma brucei gambiense (Gambiense HAT) would exacerbate or alleviate experiences of societal disadvantage that traditional economic evaluation does not take into account. Justice-enhanced cost-effectiveness analysis (JE-CEA) is a normative approach under development to address social justice considerations in public health decision-making alongside other types of analyses. It aims to assess how public health interventions under analysis in comparative evaluation would be expected to influence the clustering of disadvantage across three core dimensions of well-being: agency, association and respect. As a case study to test the approach, we applied it to five strategies for Gambiense HAT control and elimination, in combination with two different other evaluations: a cost-effectiveness analysis and a probability of elimination analysis. We have demonstrated how JE-CEA highlights the ethical importance of adverse social justice impacts of otherwise attractive options and how it indicates specific modifications to policy options to mitigate such impacts. JE-CEA holds promise as an approach to help decision makers and other stakeholders consider social justice more fully, explicitly and systematically in evaluating public health programs.
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Affiliation(s)
- Maria W Merritt
- Johns Hopkins Berman Institute of Bioethics and Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | | | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute and Universität Basel
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Winn LK, Lesser A, Menya D, Baumgartner JN, Kipkoech Kirui J, Saran I, Prudhomme-O’Meara W. Motivation and satisfaction among community health workers administering rapid diagnostic tests for malaria in Western Kenya. J Glob Health 2018. [DOI: 10.7189/jogh.06.0207028.010401] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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8
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Winn LK, Lesser A, Menya D, Baumgartner JN, Kipkoech Kirui J, Saran I, Prudhomme-O'Meara W. Motivation and satisfaction among community health workers administering rapid diagnostic tests for malaria in Western Kenya. J Glob Health 2018; 8:010401. [PMID: 29497500 PMCID: PMC5823030 DOI: 10.7189/jogh.08.010401] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The continued success of community case management (CCM) programs in low-resource settings depends on the ability of these programs to retain the community health workers (CHWs), many of whom are volunteers, and maintain their high-quality performance. This study aims to identify factors related to the motivation and satisfaction of CHWs working in a malaria CCM program in two sub-counties in Western Kenya. Methods We interviewed 70 CHWs who were trained to administer malaria rapid diagnostic tests as part of a broader study evaluating a malaria CCM program. We identified factors related to CHWs' motivation and their satisfaction with participation in the program, as well as the feasibility of program scale-up. We used principal components analysis to develop an overall CHW satisfaction score and assessed associations between this score and individual CHW characteristics as well as their experiences in the program. Results The majority of CHWs reported that they were motivated to perform their role in this malaria CCM program by a personal desire to help their community (69%). The most common challenge CHWs reported was a lack of community understanding about malaria diagnostic testing and CHWs' role in the program (39%). Most CHWs (89%) reported that their involvement in the diagnostic testing intervention had either a neutral or a net positive effect on their other CHW activities, including improving skills applicable to other tasks. CHWs who said they strongly agreed with the statement that their work with the malaria program was appreciated by the community had a 0.76 standard deviation (SD) increase in their overall satisfaction score (95% confidence interval CI = 0.10-1.24, P = 0.03). Almost all CHWs (99%) strongly agreed that they wanted to continue their role in the malaria program. Conclusions Overall, CHWs reported high satisfaction with their role in community-based malaria diagnosis, though they faced challenges primarily related to community understanding and appreciation of the services they provided. CHWs' perceptions that the malaria program generally did not interfere with their other activities is encouraging for the sustainability and scale-up of similar CHW programs.
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Affiliation(s)
| | - Adriane Lesser
- Duke University, Duke Global Health Institute, Durham, North Carolina, USA
| | - Diana Menya
- Moi University, School of Public Health, Eldoret, Kenya
| | - Joy N Baumgartner
- Duke University, Duke Global Health Institute, Durham, North Carolina, USA
| | | | - Indrani Saran
- Duke University, Duke Global Health Institute, Durham, North Carolina, USA
| | - Wendy Prudhomme-O'Meara
- Duke University, Durham, North Carolina, USA.,Duke University, Duke Global Health Institute, Durham, North Carolina, USA.,Moi University, School of Public Health, Eldoret, Kenya
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Tsukahara T, Sugahara T, Furusawa T, Hombhanje FW. Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea. Front Public Health 2018; 6:75. [PMID: 29594096 PMCID: PMC5859013 DOI: 10.3389/fpubh.2018.00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
Background In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction. Methods Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services. Results Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval −0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female. Conclusion The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers’ preferences toward girls.
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Affiliation(s)
- Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Graduate School of Economics, Hosei University, Tokyo, Japan
| | - Takuma Sugahara
- Graduate School of Economics, Hosei University, Tokyo, Japan
| | - Takuro Furusawa
- Department of Ecology and Environment, Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan
| | - Francis Wanak Hombhanje
- Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
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