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Tchinda Meli E, Bernard YM, Ateba JM, Tchoutang L, Mouliom A, Ciceron AC, Mostel J, Tchadjeu C, Palata O, Wirngo M, Fofana A, Barat LM. Impact of the Severe Malaria "Champions Program" on the Management of Severe Malaria Cases in 12 Hospitals of the North and Far North Regions of Cameroon. Am J Trop Med Hyg 2024; 110:76-82. [PMID: 38320307 PMCID: PMC10919230 DOI: 10.4269/ajtmh.23-0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
Malaria remains a main cause of morbidity and mortality in Cameroon. Since 2021, the U.S. President's Malaria Initiative Impact Malaria Project has supported the National Malaria Control Program to develop the Champions program in two northern regions. We assessed this program's preliminary effectiveness on the performance of hospitals in the management of severe malaria and reduction of malaria-related deaths. We conducted a secondary analysis of Outreach Training and Supportive Supervision (OTSS) data from four rounds (one round pre-Champions program and three rounds post-Champions program and 2020-2022 malaria-related mortality data for 12 hospitals). Using linear regressions, we measured changes in hospital readiness and competency of health workers in the management of severe malaria between baseline and subsequent rounds. There were statistically significant improvements in overall management of severe malaria scores in post-Champions OTSS rounds, with post-Champions round 3 exhibiting an increase of +14% (P = 0.013) over baseline. Overall health facility readiness scores exhibited an increase of +7% (P = 0.006) from baseline to post-Champions round 3. There were no statistically significant findings associated with providing the right treatment, as nearly all patients hospitalized with severe malaria were treated with a recommended severe malaria treatment. Reported inpatient malaria deaths and case fatality rates trended downward from 2020 to 2022, but these differences were not statistically significant. The Champions program resulted in significant improvements in quality of inpatient care for severe malaria. The downward trends in malaria deaths and case fatality rate will require further monitoring to determine whether the Champions program is having the desired impact of reducing inpatient deaths from malaria.
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Affiliation(s)
- Eric Tchinda Meli
- U.S. President’s Malaria Initiative Impact Malaria Project, Jhpiego, Yaoundé, Cameroon
| | - Yves-Marie Bernard
- U.S. President’s Malaria Initiative Impact Malaria Project, Population Services International, Washington, District of Columbia
| | | | - Landry Tchoutang
- U.S. President’s Malaria Initiative Impact Malaria Project, Association Camerounaise pour le Marketing Social, Yaoundé, Cameroon
| | - Abas Mouliom
- U.S. President’s Malaria Initiative Impact Malaria Project, Association Camerounaise pour le Marketing Social, Yaoundé, Cameroon
| | - Annie Coriolan Ciceron
- U.S. President’s Malaria Initiative Impact Malaria Project, Population Services International, Washington, District of Columbia
| | - Jadmin Mostel
- U.S. President’s Malaria Initiative Impact Malaria Project, Population Services International, Washington, District of Columbia
| | - Christophe Tchadjeu
- U.S. President’s Malaria Initiative Impact Malaria Project, Association Camerounaise pour le Marketing Social, Yaoundé, Cameroon
| | - Olivier Palata
- U.S. President’s Malaria Initiative Impact Malaria Project, Association Camerounaise pour le Marketing Social, Yaoundé, Cameroon
| | - Mohamadu Wirngo
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Yaoundé, Cameroon
| | - Aissata Fofana
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Yaoundé, Cameroon
| | - Lawrence M. Barat
- U.S. President’s Malaria Initiative Impact Malaria Project, Population Services International, Washington, District of Columbia
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Bernard YM, Ahmed J, Mostel J, Ba T, Ciceron AC, Busiga M, Koné A, Kamaté B, Sidibé F, Diallo C, Makayi A, Koko DC, Djibrilla A, Ateba J, Tchinda Meli E, Tchadjeu C, Griffith K, Burns J, Barat LM. Clinical Outreach Training and Supportive Supervision Quality-of-Care Analysis: Impact of Readiness Factors on Health Worker Competencies in Malaria Case Management in Cameroon, Mali, and Niger. Am J Trop Med Hyg 2024; 110:35-41. [PMID: 38150737 PMCID: PMC10919239 DOI: 10.4269/ajtmh.23-0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/02/2023] [Indexed: 12/29/2023] Open
Abstract
Improving the quality of malaria clinical case management in health facilities is key to improving health outcomes in patients. The U.S. President's Malaria Initiative Impact Malaria Project has supported implementation of the Outreach Training and Supportive Supervision (OTSS) approach in 11 African countries to improve the quality of malaria care in health facilities through the collection and analysis of observation-based data on health facility readiness and health provider competency in malaria case management. We conducted a secondary analysis of longitudinal data collected during routine supervision in Cameroon (April 2021-March 2022), Mali (October 2020-December 2021), and Niger (November 2020-September 2021) using digitized checklists to assess how service readiness affects health worker competencies in managing patients with fever correctly and providing those with confirmed uncomplicated malaria cases with appropriate treatment and referral. Linear or logistic regression analyses were conducted to assess the effect of facility readiness and its components on observed health worker competencies. All countries demonstrated significant associations between health facility readiness and malaria case management competencies. Data from three rounds of OTSS visits in Cameroon, Mali, and Niger showed a statistically significant positive association between greater facility readiness scores (including the availability of commodities, materials, and trained staff) and health worker competency in case management. These findings provide evidence that health worker performance is likely affected by the tools and training available to them. These results reinforce the need for necessary tools and properly trained staff if high-quality malaria case management services are to be delivered at health facilities.
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Affiliation(s)
- Yves-Marie Bernard
- PMI Impact Malaria, Population Services International, Washington, District of Columbia
| | - Jehan Ahmed
- PMI Impact Malaria, Population Services International, Washington, District of Columbia
| | - Jadmin Mostel
- PMI Impact Malaria, Population Services International, Washington, District of Columbia
| | - Thierno Ba
- PMI Impact Malaria, Population Services International, Washington, District of Columbia
| | | | - Moses Busiga
- PMI Impact Malaria, Population Services International, Washington, District of Columbia
| | - Aissata Koné
- Programme National de Lutte contre le Paludisme du Mali, Bamako, Mali
| | - Beh Kamaté
- PMI Impact Malaria, Population Services International, Bamako, Mali
| | - Fatoumata Sidibé
- PMI Impact Malaria, Population Services International, Bamako, Mali
| | - Chebou Diallo
- PMI Impact Malaria, Population Services International, Bamako, Mali
| | - Alzouma Makayi
- Programme National de Lutte contre le Paludisme du Niger, Niamey, Niger
| | | | - Arouna Djibrilla
- PMI Impact Malaria, Population Services International, Niamey, Niger
| | - Joël Ateba
- Programme National de Lutte contre le Paludisme du Cameroun, Yaoundé, Cameroon
| | | | - Christophe Tchadjeu
- PMI Impact Malaria, Association Camerounaise pour le Marketing Social, Yaoundé, Cameroon
| | - Kevin Griffith
- U.S. President’s Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Jordan Burns
- U.S. President’s Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Lawrence M. Barat
- PMI Impact Malaria, Population Services International, Washington, District of Columbia
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Akafity G, Kumi N, Ashong J. Diagnosis and management of malaria in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:3-15. [PMID: 38263976 PMCID: PMC10800773 DOI: 10.1016/j.jointm.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 01/25/2024]
Abstract
Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year. Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia, where the disease is endemic. In non-endemic areas, malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs. Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy, recognition of complications, and appropriate supportive care. However, the lack of diagnostic capacities due to limited advances in equipment, personnel, and infrastructure presents a challenge to the effective diagnosis and management of malaria. This article reviews the clinical classification, diagnosis, and management of malaria as relevant to critical care clinicians, highlighting the role of diagnostic capacity, treatment options, and supportive care.
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Affiliation(s)
- George Akafity
- Department of Research, Monitoring, and Evaluation, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Nicholas Kumi
- Intensive Care Unit, Department of Critical Care and Anesthesia, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joyce Ashong
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
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Akpan U, Edet E, Arogundade K, Akpanika C, Ekott M, Etuk S. Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State. Health Serv Insights 2023; 16:11786329231211779. [PMID: 38028122 PMCID: PMC10658768 DOI: 10.1177/11786329231211779] [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: 01/18/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background There has been a concerted effort to reduce malaria burden and bring malaria related mortality to zero. The objectives of this survey were to assess the level of adherence to the current revised malaria control guidelines in the public health facilities in Cross River State of Nigeria and to identify the challenges as well as suggest ways for improvement in treatment outcomes. Methods This was a mixed observational and qualitative survey conducted in 32 public health facilities from 21st to 25th June 2022. Treatment records on malaria were assessed for adherence to the National guidelines. In-depth interviews were conducted with 36 key informants and 4 purposefully selected stakeholders to identify the successes and challenges. Quantitative data were summarized and presented in simple proportions and percentages while qualitative information was recorded, the transcripts thematically coded, analyzed and presented using NVivo 11 software. Results The survey revealed that vector control program was poorly implemented across the state. For case management, presumptive treatment was frequently practiced especially at secondary health facilities for uncomplicated malaria. More than 60% of uncomplicated malaria were being treated with parenteral artemether instead of oral artemisinin combination therapy (ACTs) as recommended. Severe malaria were not treated with Intravenous (IV) Artesunate as first line drug in about 40% of the secondary health facilities. Key successes were noted in malaria management in pregnancy. Major challenges identified include: stock out of commodities, shortage of clinical man power, and low trust in parasitological diagnosis. Conclusion The survey showed that adherence to the key recommendations in various categories of malaria control among health care providers in the public health facilities was below expectation. Malaria preventive treatment in pregnancy with SP fared better perhaps because of its inclusion in ANC packages.
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Affiliation(s)
- Ubong Akpan
- Maternal-Foetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Calabar, Cross River State, Calabar, Nigeria
| | - Ekpo Edet
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Cross River State, Calabar, Nigeria
| | | | - Chinyere Akpanika
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Cross River State, Calabar, Nigeria
| | - Mabel Ekott
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Cross River State, Calabar, Nigeria
| | - Saturday Etuk
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Cross River State, Calabar, Nigeria
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Chen Y, Zhang H, Chen H, Fan L, Xu C, Xu J, Chen S, Chen K, Wei Y. Malaria epidemiological characteristics and control in Guangzhou, China, 1950-2022. Malar J 2023; 22:265. [PMID: 37691114 PMCID: PMC10494454 DOI: 10.1186/s12936-023-04696-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Malaria was once widespread in Guangzhou, China. However, a series of control measures have succeeded in eliminating local malaria infections. Based on the analysis of the characteristics of malaria epidemics in Guangzhou, China, from 1950 to 2022, the changes and effectiveness of malaria control strategies and surveillance management in Guangzhou from 1950 to 2022 are described. METHODS Data on malaria prevention and treatment in Guangzhou from 1950 to 2022 were collected, and descriptive epidemiological methods were used to analyse the prevalence of malaria, preventive and control measures taken, and the effectiveness of prevention and treatment in different periods. Data on malaria cases were obtained from the Guangzhou Centre for Disease Control and Prevention (CDC) and the China Communicable Disease Reporting System. RESULTS The development of the malaria control system in Guangzhou has gone through four periods: 1. High malaria prevalence (1950-1979), 2. Intensive prevention and control stage (1980-2000), 3. Consolidating gains in malaria control (2001-2008), and 4. Preventing reestablishment of transmission (2009-2022). During Period 1, only medical institutions at all levels and the local CDCs, the Guangzhou CDC participated in the malaria prevention and control system, establishing a three-tier health system on malaria prevention and control. During Period 2, other types of organizations, including the agricultural sector, schools and village committees, the construction department and street committee, are involved in the malaria control system. During Period 3, more and more organizations are joining forces to prevent and control malaria. A well-established multisectoral malaria control mechanism and an improved post-elimination surveillance management system are in place. Between 1950 and 2022, a total of 420,670 cases of malaria were reported. During Period 1, there was an epidemic of malaria in the early 1950s, with an annual incidence rate of more than 10,000/100,000, including a high rate of 2887.98/100,000 in 1954. In Period 2 malaria was gradually brought under control, with the average annual malaria incidence rate dropping to 3.14/100,000. During Period 3, the incidence rate was kept below 1/100,000, and by 2009 local malaria infections were eliminated. CONCLUSION For decades, Guangzhou has adopted different malaria control strategies and measures at different epidemic stages. Increased collaboration among civil organizations in Guangzhou in malaria control has led to a significant decline in the number of malaria cases and the elimination of indigenous malaria infections by 2009.The experience of Guangzhou can guide the development of malaria control strategies in other cities experiencing similar malaria epidemics.
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Affiliation(s)
- Yuehua Chen
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Hao Zhang
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Haiyan Chen
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Lirui Fan
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Conghui Xu
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jianmin Xu
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Shouyi Chen
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Kuncai Chen
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuehong Wei
- Institute of Public Health, Guangzhou Medical University, Guangzhou, China.
- Department of Parasite and Endemic Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
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Azizi H, Davtalab Esmaeili E, Abbasi F. Availability of malaria diagnostic tests, anti-malarial drugs, and the correctness of treatment: a systematic review and meta-analysis. Malar J 2023; 22:127. [PMID: 37072759 PMCID: PMC10111310 DOI: 10.1186/s12936-023-04555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/07/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Health facilities' availability of malaria diagnostic tests and anti-malarial drugs (AMDs), and the correctness of treatment are critical for the appropriate case management, and malaria surveillance programs. It is also reliable evidence for malaria elimination certification in low-transmission settings. This meta-analysis aimed to estimate summary proportions for the availability of malaria diagnostic tests, AMDs, and the correctness of treatment. METHODS The Web of Science, Scopus, Medline, Embase, and Malaria Journal were systematically searched up to 30th January 2023. The study searched any records reporting the availability of diagnostic tests and AMDs and the correctness of malaria treatment. Eligibility and risk of bias assessment of studies were conducted independently in a blinded way by two reviewers. For the pooling of studies, meta-analysis using random effects model were carried out to estimate summary proportions of the availability of diagnostic tests, AMDs, and correctness of malaria treatment. RESULTS A total of 18 studies, incorporating 7,429 health facilities, 9,745 health workers, 41,856 febrile patients, and 15,398 malaria patients, and no study in low malaria transmission areas, were identified. The pooled proportion of the availability of malaria diagnostic tests, and the first-line AMDs in health facilities was 76% (95% CI 67-84); and 83% (95% CI 79-87), respectively. A pooled meta-analysis using random effects indicates the overall proportion of the correctness of malaria treatment 62% (95% CI 54-69). The appropriate malaria treatment was improved over time from 2009 to 2023. In the sub-group analysis, the correctness of treatment proportion was 53% (95% CI 50-63) for non-physicians health workers and 69% (95% CI 55-84) for physicians. CONCLUSION Findings of this review indicated that the correctness of malaria treatment and the availability of AMDs and diagnostic tests need improving to progress the malaria elimination stage.
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Affiliation(s)
- Hosein Azizi
- Research Centre for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Fariba Abbasi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Diseases Control and Prevention, Vice-chancellor for Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Ge Y, Liang D, Cao J, Gosling R, Mushi V, Huang J. How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries. Infect Dis Poverty 2023; 12:29. [PMID: 37024969 PMCID: PMC10077698 DOI: 10.1186/s40249-023-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries. However, more remains to be known about how a patient's socioeconomic status (SES) would affect the access to diagnosis of malaria. METHODS In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey, we pooled the data of 38,567 febrile under-five children in 2016-2018 from 19 sub-Saharan countries. Multivariable logistic regression was used to assess the associations between SES and two binary outcomes: the visit to a health facility and a blood test for fever. Stratified analyses were further conducted by the type of health facilities (public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities) for the latter outcome. RESULTS Fifty-eight percent of the febrile children were taken to health facilities, among whom only 55% took blood tests. Compared to children from households in the highest wealth quintile, children in the lowest quintile were less likely to be taken to medical facilities [adjusted odds ratio (aOR) = 0.775, 95% confidence interval (CI): 0.675-0.889]. Parents with more than secondary education were more likely to seek care (aOR = 1.830, 95% CI: 1.561-2.145) and to have blood tests (aOR = 1.729, 95% CI: 1.436-2.082) for their febrile children than parents without formal education. The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles, while these probabilities remained the lowest at private primary healthcare facilities, ranging from 0.100 (95% CI: 0.074-0.127) to 0.139 (95% CI: 0.083-0.194) across parental education levels and from 0.104 (95% CI: 0.078-0.130) to 0.125 (95% CI: 0.090-0.160) across wealth quintiles. CONCLUSIONS Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries. These disparities were particularly evident in the private sector. Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.
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Affiliation(s)
- Yue Ge
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
| | - Di Liang
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
| | - Jun Cao
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
- Key Laboratory of National Health Commission on Parasitic Disease Control and Prevention, Key Laboratory of Jiangsu Province on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Roland Gosling
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Vivian Mushi
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jiayan Huang
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China.
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Mangeni JN, Abel L, Taylor SM, Obala A, O'Meara WP, Saran I. Experience and confidence in health technologies: evidence from malaria testing and treatment in Western Kenya. BMC Public Health 2022; 22:1689. [PMID: 36068516 PMCID: PMC9446607 DOI: 10.1186/s12889-022-14102-y] [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: 05/03/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Low adoption of effective health technologies increases illness morbidity and mortality worldwide. In the case of malaria, effective tools such as malaria rapid diagnostic tests (RDTs) and artemisinin-combination therapies (ACTs) are both under-used and used inappropriately. Individuals’ confidence in RDTs and ACTs likely affects the uptake of these tools. Methods In a cohort of 36 households (280 individuals) in Western Kenya observed for 30 months starting in June 2017, we examined if experience with RDTs and ACTs changes people’s beliefs about these technologies and how those beliefs affect treatment behavior. Household members requested a free RDT from the study team any time they suspected a malaria illness, and positive RDT results were treated with a free ACT. We conducted annual, monthly, and sick visit surveys to elicit beliefs about the accuracy of malaria RDT results and the effectiveness of ACTs. Beliefs were elicited on a 5-point Likert scale from “very unlikely” to “very likely.” Results Over the study period, the percentage of survey respondents that said a hypothetical negative RDT result was “very likely” to be correct increased from approximately 55% to 75%. Controlling for initial beliefs, people who had been tested at least once with an RDT in the past year had 3.6 times higher odds (95% CI [1 1.718 7.679], P = 0.001) of saying a negative RDT was “very likely” to be correct. Confidence in testing was associated with treatment behavior: those who believed a negative RDT was “very likely” to be correct had 1.78 times higher odds (95% CI [1.079 2.934], P = 0.024) of adhering to a negative RDT result (by not taking ACTs) than those who were less certain about the accuracy of negative RDTs. Adherence to a negative test also affected subsequent beliefs: controlling for prior beliefs, those who had adhered to their previous test result had approximately twice the odds (OR = 2.19, 95% CI [1.661 2.904], P < 0.001) of saying that a hypothetical negative RDT was “very likely” to be correct compared to those who had not adhered. Conclusions Our results suggest that greater experience with RDTs can not only increase people’s confidence in their accuracy but also improve adherence to the test result. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14102-y.
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Affiliation(s)
- Judith N Mangeni
- School of Public Health, College of Health Sciences, Moi University, P.O BOX 512-30100, Eldoret, Kenya.
| | - Lucy Abel
- Academic Model Providing Access to Healthcare, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Steve M Taylor
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, NC, USA
| | - Andrew Obala
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | | | - Indrani Saran
- Boston College of Social Work, McGuinn Hall 305, Newton, MA, USA
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Wang W, Liu M, Xu J, Li L, Tan J, Guo JJ, Lu K, Li G, Sun X. Impact of time-varying exposure on estimated effects in observational studies using routinely collected data: protocol for a cross-sectional study. BMJ Open 2022; 12:e062572. [PMID: 35788067 PMCID: PMC9255408 DOI: 10.1136/bmjopen-2022-062572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Time-varying exposure is an important issue that should be addressed in longitudinal observational studies using routinely collected data (RCD) for drug treatment effects. How well investigators designed, analysed and reported time-varying exposure, and to what extent the divergence that can be observed between different methods used for handling time-varying exposure in these studies remains uncertain. We will conduct a cross-sectional study to comprehensively address this question. METHODS AND ANALYSIS We have developed a comprehensive search strategy to identify all studies exploring drug treatment effects including both effectiveness and safety that used RCD and were published in core journals between 2018 and 2020. We will collect information regarding general study characteristics, data source profile, methods for handling time-varying exposure, results and the interpretation of findings from each eligibility. Paired reviewers will screen and extract data, resolving disagreements through discussion. We will describe the characteristics of included studies, and summarise the method used for handling time-varying exposure in primary analysis and sensitivity analysis. We will also compare the divergence between different approaches for handling time-varying exposure using ratio of risk ratios. ETHICS AND DISSEMINATION No ethical approval is required because the data we will use do not include individual patient data. Findings will be disseminated through peer-reviewed publications.
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Affiliation(s)
- Wen Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Mei Liu
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Jiayue Xu
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Ling Li
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Jing Tan
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Jeff Jianfei Guo
- College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kevin Lu
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Guowei Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
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10
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Brisset J, Angendu Baki K, Watier L, Kinkpé E, Bailly J, Ayédadjou L, Alao MJ, Dossou-Dagba I, Bertin GI, Cot M, Boumédiène F, Ajzenberg D, Aubouy A, Houzé S, Faucher JF, Affolabi D, Argy N, Biokou B, Degbelo JE, Calavi, Benin, Deloron P, Dramane L, Fraering J, Guillochon E, Jafari-Guemouri S, Houzé L, Joste V, Kamaliddin C, Labrunie A, Ladipo Y, Lathiere T, Massougbodji A, Mowendabeka A, Papin J, Pipy B, Preux PM, Raymondeau M, Royo J, Sossou D, Techer B, Vianou B. Non-traumatic coma in young children in Benin: are viral and bacterial infections gaining ground on cerebral malaria? Infect Dis Poverty 2022; 11:29. [PMID: 35287726 PMCID: PMC8919613 DOI: 10.1186/s40249-022-00956-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background While malaria morbidity and mortality have declined since 2000, viral central nervous system infections appear to be an important, underestimated cause of coma in malaria-endemic Eastern Africa. We aimed to describe the etiology of non-traumatic comas in young children in Benin, as well as their management and early outcomes, and to identify factors associated with death. Methods From March to November 2018, we enrolled all HIV-negative children aged between 2 and 6 years, with a Blantyre Coma Score ≤ 2, in this prospective observational study. Children were screened for malaria severity signs and assessed using a systematic diagnostic protocol, including blood cultures, malaria diagnostics, and cerebrospinal fluid analysis using multiplex PCR. To determine factors associated with death, univariate and multivariate analyses were performed. Results From 3244 admissions, 84 children were included: malaria was diagnosed in 78, eight of whom had a viral or bacterial co-infection. Six children had a non-malarial infection or no identified cause. The mortality rate was 29.8% (25/84), with 20 children dying in the first 24 h. Co-infected children appeared to have a poorer prognosis. Of the 76 children who consulted a healthcare professional before admission, only 5 were prescribed adequate antimalarial oral therapy. Predictors of early death were jaundice or increased bilirubin [odd ratio (OR)= 8.6; 95% confidential interval (CI): 2.03–36.1] and lactate > 5 mmol/L (OR = 5.1; 95% CI: 1.49–17.30). Antibiotic use before admission (OR = 0.1; 95% CI: 0.02–0.85) and vaccination against yellow fever (OR = 0.2, 95% CI: 0.05–0.79) protected against mortality. Conclusions Infections were found in all children who died, and cerebral malaria was by far the most common cause of non-traumatic coma. Missed opportunities to receive early effective antimalarial treatment were common. Other central nervous system infections must be considered in their management. Some factors that proved to be protective against early death were unexpected. Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-00956-2.
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11
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Clarke‐Deelder E, Eliakimu E, Mbatia R, Bohren MA, Mashasi I, Larson E. Measuring user experience of care among caregivers of sick children: validation and descriptive analysis in a sample of 75 health facilities in rural Tanzania. Trop Med Int Health 2022; 27:317-329. [DOI: 10.1111/tmi.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emma Clarke‐Deelder
- Department of Epidemiology and Public Health Swiss Tropical and Public Health Institute Basel Switzerland
| | - Eliudi Eliakimu
- Health Quality Assurance Unit Ministry of Health, Community Development Gender, Elderly and Children Dodoma Tanzania
| | | | - Meghan A. Bohren
- Gender and Women’s Health Unit Centre for Health Equity School of Population and Global Health University of Melbourne Melbourne Australia
| | - Irene Mashasi
- Management and Development for Health Dar es Salaam Tanzania
| | - Elysia Larson
- Department of Obstetrics and Gynecology Beth Israel Deaconess Medical Center and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School Boston USA
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12
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Leslie HH, Hategeka C, Ndour PI, Nimako K, Dieng M, Diallo A, Ndiaye Y. Stability of healthcare quality measures for maternal and child services: Analysis of the continuous service provision assessment of health facilities in Senegal, 2012-2018. Trop Med Int Health 2021; 27:68-80. [PMID: 34865274 PMCID: PMC9300084 DOI: 10.1111/tmi.13701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective High‐quality healthcare is essential to ensuring maternal and newborn survival. Efficient measurement requires knowing how long measures of quality provide consistent insight for intended uses. Methods We used a repeated health facility assessment in Senegal to calculate structural and process quality of antenatal care (ANC), delivery and child health services in facilities assessed 2 years apart. We tested agreement of quality measures within facilities and regions. We estimated how much input‐adjusted and process quality‐adjusted coverage measures changed for each service when calculated using quality measurements from the same facilities measured 2 years apart. Results Over 6 waves of continuous surveys, 628 paired assessments were completed. Changes at the facility level were substantial and often positive, but inconsistent. Structural quality measures were moderately correlated (0.40–0.69) within facilities over time, more so in hospitals; correlation was <0.20 for process measures based on direct observation of ANC and child visits. Most measures were more strongly correlated once averaged to regions; process quality of child services was not (−0.32). Median relative difference in national‐adjusted coverage estimates was 6.0%; differences in subnational estimates were largest for process quality of child services (19.6%). Conclusion Continuous measures of structural quality demonstrated consistency at regional levels and in higher level facilities over 2 years; results for process measures were mixed. Direct observation of child visits provided inconsistent measures over time. For other measures, linking population data with health facility assessments from up to 2 years prior is likely to introduce modest measurement error in adjusted coverage estimates.
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Affiliation(s)
- Hannah H Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, California, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Papa Ibrahima Ndour
- Directorate of Planning, Research, and Statistics, Ministry of Health and Social Action, Dakar, Senegal.,Agence Nationale de la Démographie et de la Statistique, Dakar, Senegal
| | | | - Mamadou Dieng
- Directorate of Planning, Research, and Statistics, Ministry of Health and Social Action, Dakar, Senegal
| | - Abdoulaye Diallo
- Directorate of Planning, Research, and Statistics, Ministry of Health and Social Action, Dakar, Senegal
| | - Youssoupha Ndiaye
- Directorate of Planning, Research, and Statistics, Ministry of Health and Social Action, Dakar, Senegal
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13
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Azizi H, Majdzadeh R, Ahmadi A, Esmaeili ED, Naghili B, Mansournia MA. Health workers readiness and practice in malaria case detection and appropriate treatment: a meta-analysis and meta-regression. Malar J 2021; 20:420. [PMID: 34689791 PMCID: PMC8543935 DOI: 10.1186/s12936-021-03954-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Health workers (HWs) appropriate malaria case management includes early detection and prompt treatment with appropriate anti-malarial drugs. Subsequently, HWs readiness and practice are considered authentic evidence to measure the health system performance regarding malaria control programme milestones and to issue malaria elimination certification. There is no comprehensive evidence based on meta-analysis, to measure the performance of HWs in case management of malaria. This study aimed to evaluate HWs performance in early malaria case detection (testing) and the appropriate treatment. Methods The published literature in English was systematically searched from Medline, Scopus, Embase, and Malaria Journal up to 30th December 2020. The inclusion criteria were any studies that assessed HWs practice in early case detection by malaria testing and appropriate treatment. Eligibility assessment of records was performed independently in a blinded, standardized way by two reviewers. Pooled prevalence estimates were stratified by HWs cadre type. Meta-regression analysis was performed to explore the impact of the appropriateness of the method and risk of bias as potential sources of the heterogeneity in the presence of effective factors. Results The study pooled data of 9245 HWs obtained from 15 included studies. No study has been found in eliminating settings. The pooled estimate for appropriate malaria treatment and malaria testing were 60%; 95% CI: 53–67% and 57%; 95% CI: 49–65%, respectively. In the final multivariable meta-regression, HWs cadre and numbers, appropriateness of study methods, malaria morbidity and mortality, total admissions of malaria suspected cases, gross domestic product, availability of anti-malarial drugs, and year of the publication were explained 85 and 83% of the total variance between studies and potential sources of the heterogeneity for malaria testing and treating, respectively. Conclusion HWs adherence to appropriate malaria case management guidelines were generally low while no study has been found in eliminating countries. Studies with the inappropriateness methods and risk of bias could be overestimating the actual proportion of malaria appropriate testing and treating. Strategies that focus on improving readiness and early identification of acute febrile diseases especially in the countries that progress to malaria elimination should be highly promoted.
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Affiliation(s)
- Hosein Azizi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Public Health, Knowledge Utilization Research Center, and Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Davtalab Esmaeili
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrouz Naghili
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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14
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Genotyping cognate Plasmodium falciparum in humans and mosquitoes to estimate onward transmission of asymptomatic infections. Nat Commun 2021; 12:909. [PMID: 33568678 PMCID: PMC7875998 DOI: 10.1038/s41467-021-21269-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/15/2021] [Indexed: 01/30/2023] Open
Abstract
Malaria control may be enhanced by targeting reservoirs of Plasmodium falciparum transmission. One putative reservoir is asymptomatic malaria infections and the scale of their contribution to transmission in natural settings is not known. We assess the contribution of asymptomatic malaria to onward transmission using a 14-month longitudinal cohort of 239 participants in a high transmission site in Western Kenya. We identify P. falciparum in asymptomatically- and symptomatically-infected participants and naturally-fed mosquitoes from their households, genotype all parasites using deep sequencing of the parasite genes pfama1 and pfcsp, and use haplotypes to infer participant-to-mosquito transmission through a probabilistic model. In 1,242 infections (1,039 in people and 203 in mosquitoes), we observe 229 (pfcsp) and 348 (pfama1) unique parasite haplotypes. Using these to link human and mosquito infections, compared with symptomatic infections, asymptomatic infections more than double the odds of transmission to a mosquito among people with both infection types (Odds Ratio: 2.56; 95% Confidence Interval (CI): 1.36-4.81) and among all participants (OR 2.66; 95% CI: 2.05-3.47). Overall, 94.6% (95% CI: 93.1-95.8%) of mosquito infections likely resulted from asymptomatic infections. In high transmission areas, asymptomatic infections are the major contributor to mosquito infections and may be targeted as a component of transmission reduction.
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