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Didi L, Abakar MF, Bongo Naré Richard N, Djané A, Kessely H, Issaka Y, Diagbouba S, Adrien Marie Gaston B, Zinsstag J, Bonfoh B, Dürr S. Assessment of the knowledge, attitudes, and practices toward human tuberculosis amongst rural communities in Chad. Front Vet Sci 2024; 11:1334303. [PMID: 38818496 PMCID: PMC11137331 DOI: 10.3389/fvets.2024.1334303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/29/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Tuberculosis (TB) is an infectious zoonotic disease caused by bacteria belonging to the Mycobacterium tuberculosis complex. In sub-Saharan African countries such as Chad, TB is endemic and causes a high burden on humans and animals through morbidity, mortality, and reduced productivity in livestock. To effectively prevent and control the disease, strong coordination between policymakers, health and veterinary services, civil society organizations, and communities is needed. It also requires an understanding of the knowledge the communities have regarding TB. However, such knowledge is under-investigated, especially in rural areas. How knowledge affects people's attitudes and practices is also unclear. The main objective of this study was to investigate the knowledge, attitudes, and practices (KAP) of Chadian rural communities to better involve them in TB surveillance programs. Methods A survey was conducted in 2021 in five rural health centers. Face-to-face interviews were conducted with persons suspected of having TB, and data on KAP were recorded and analyzed. Results In total, 139 participants were enrolled. Overall, the knowledge and attitude of the participants were found to be good to moderate, with 126 (90.6%) and 97 (69.7%) having good knowledge and attitude, respectively. However, their practices were found to be rather weak, with only 40 (28.7%) participants having good practices. Men were found to have good knowledge about the disease significantly more often than women. Poor attitude was significantly associated with a mobile lifestyle compared to settled lifestyles and with farmers (mainly engaged in agriculture) compared to breeders (livestock keepers). Poor health practices were associated more with men than women and with settled lifestyles compared to a mobile lifestyle. Good practices were found to be in line with good knowledge and good attitudes; however, in the analyses, the association was not significant [OR knowledge = 5.83 (95% C.I. 0.6842.83), p = 0.112; OR attitude = 2.09 (95% C.I. 0.875.04), p = 0.100]. Furthermore, attitude was not associated with knowledge [OR = 1.03 (95% C.I. 0.303.55), p = 0.964]. Discussion and conclusion Our study highlights the need for targeted sensitization and awareness campaigns for communities with poor knowledge and attitudes regarding TB. These campaigns should also include practical training to increase the level of good practice rather than simply providing knowledge.
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Affiliation(s)
- Lamireou Didi
- Institut de Recherche en Elevage Pour le Développement, N'Djamena, Chad
| | | | | | - Adou Djané
- Centre Suisse de Recherches Scientifiques (CSRS), Adiopodoume, Côte d'Ivoire
- Institut National de Santé Publique (INSP) Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Hamit Kessely
- Centre de Support en Santé Internationale–Programme d'Appui au District Sanitaires au Tchad, N'Djamena, Chad
| | - Yaya Issaka
- Centre de Support en Santé Internationale–Programme d'Appui au District Sanitaires au Tchad, N'Djamena, Chad
| | - Serge Diagbouba
- Université Nazi Boni, Ecole Doctorale Sciences et Agronomie: Biologie Appliquée et Modélisation des Systèmes Biologiques, Bobo Dioulasso, Burkina Faso
| | - Belem Adrien Marie Gaston
- Université Nazi Boni, Ecole Doctorale Sciences et Agronomie: Biologie Appliquée et Modélisation des Systèmes Biologiques, Bobo Dioulasso, Burkina Faso
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques (CSRS), Adiopodoume, Côte d'Ivoire
| | - Salome Dürr
- Veterinary and Public Health Institute, Faculty of Vetsuisse, University of Bern, Bern, Switzerland
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Doras C, Özcelik R, Abakar MF, Issa R, Kimala P, Youssouf S, Bolon I, Dürr S. Community-based symptom reporting among agro-pastoralists and their livestock in Chad in a One Health approach. Acta Trop 2024; 253:107167. [PMID: 38458407 DOI: 10.1016/j.actatropica.2024.107167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/02/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
One Health Syndromic Surveillance has a high potential for detecting early epidemiological events in remote and hard-to-reach populations. Chadian pastoralists living close to their animals and being socio-economically unprivileged have an increased risk for zoonosis exposure. Engaging communities in disease surveillance could also strengthen preparedness capacities for outbreaks in rural Chad. This study describes a retrospective cross-sectional survey that collected data on clinical symptoms reported in people and livestock in Chadian agro-pastoral communities. In January-February 2018, interviews were conducted in rural households living in nomadic camps or settled villages in the Yao and Danamadji health districts. The questionnaire covered demographic data and symptoms reported in humans and animals for the hot, wet, and cold seasons over the last 12 months. Incidence rates of human and animal symptoms were comparatively analyzed at the household level. Ninety-two households with a homogeneous socio-demographic distribution were included. We observed cough and diarrhea as the most frequent symptoms reported simultaneously in humans and animals. In all species, the incidence rate of cough was significantly higher during the cold season, and diarrhea tended to occur more frequently during the wet season. However, the incidence rate of cough and diarrhea in animals did not predict the incidence rate of these symptoms in humans. Overall, the variations in reported symptoms were consistent with known seasonal, regional, and sociological influences on endemic diseases. Our retrospective study demonstrated the feasibility of collecting relevant health data in humans and animals in remote regions with low access to health services by actively involving community members. This encourages establishing real-time community-based syndromic surveillance in areas such as rural Chad.
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Affiliation(s)
- Camille Doras
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Veterinary Public Health Institute, Vetsuisse Faculty Bern, University of Bern, Bern, Switzerland
| | - Ranya Özcelik
- Veterinary Public Health Institute, Vetsuisse Faculty Bern, University of Bern, Bern, Switzerland
| | | | - Ramadan Issa
- Institut de Recherche en Elevage pour le Développement (IRED), N'Djamena, Chad
| | - Pidou Kimala
- Institut de Recherche en Elevage pour le Développement (IRED), N'Djamena, Chad
| | - Soumaya Youssouf
- Institut de Recherche en Elevage pour le Développement (IRED), N'Djamena, Chad
| | - Isabelle Bolon
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Salome Dürr
- Veterinary Public Health Institute, Vetsuisse Faculty Bern, University of Bern, Bern, Switzerland.
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Adams MW, Sutherland EG, Eckert EL, Saalim K, Reithinger R. Leaving no one behind: targeting mobile and migrant populations with health interventions for disease elimination-a descriptive systematic review. BMC Med 2022; 20:172. [PMID: 35527246 PMCID: PMC9082871 DOI: 10.1186/s12916-022-02365-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mobile and migrant populations (MMPs) pose a unique challenge to disease elimination campaigns as they are often hard to survey and reach with treatment. While some elimination efforts have had success reaching MMPs, other campaigns are struggling to do so, which may be affecting progress towards disease control and elimination. Therefore, this paper reviews the literature on elimination campaigns targeting MMPs across a selection of elimination diseases-neglected tropical diseases, malaria, trypanosomiasis, polio, smallpox, and rinderpest. METHODS Through a systematic review process following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a three-person review team identified papers from databases, conference records, and citation searches using inclusion/exclusion criteria. Papers were divided into three key outcome domains during the synthetization process: (1) MMP movement patterns in East Africa including reasons for movement and consequences in terms of health outcomes and healthcare access; (2) MMP contribution to the transmission of disease across all geographies; (3) surveillance methods and treatment interventions used to implement programming in MMPs across all geographies. Experts in the field also provided supplemental information and gray literature to support this review. RESULTS The review identified 103 records which were descriptively analyzed using the outcome domains. The results indicate that in East Africa, there are various motivations for migration from economic opportunity to political unrest to natural disasters. Regardless of motivation, mobile lifestyles affect health service access such that MMPs in East Africa report barriers in accessing healthcare and have limited health knowledge. Often lower service delivery to these populations has resulted in higher disease prevalence. A minority of articles suggest MMPs do not pose challenges to reaching disease control and elimination thresholds. Finally, the literature highlighted surveillance methods (e.g., using satellite imagery or mobile phone data to track movement, participatory mapping, snowball sampling) and intervention strategies (e.g., integration with animal health campaigns, cross-border coordination, alternative mass drug administration [MDA] methods) to implement health interventions in MMPs. CONCLUSIONS Ultimately, the literature reviewed here can inform programmatic decisions as the community attempts to reach these never treated populations. SYSTEMATIC REVIEW REGISTRATION The protocol for this manuscript was registered with the International Prospective Registry of Systematic Reviews (PROSPERO) (No. CRD42021214743).
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Affiliation(s)
- Molly W Adams
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
| | - Elizabeth G Sutherland
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
| | - Erin L Eckert
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
| | - Khalida Saalim
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
| | - Richard Reithinger
- Research Triangle Institute (RTI) International, 701 13th St NW Ste 750, Washington , DC, 20005 USA
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Worsley-Tonks KEL, Bender JB, Deem SL, Ferguson AW, Fèvre EM, Martins DJ, Muloi DM, Murray S, Mutinda M, Ogada D, Omondi GP, Prasad S, Wild H, Zimmerman DM, Hassell JM. Strengthening global health security by improving disease surveillance in remote rural areas of low-income and middle-income countries. Lancet Glob Health 2022; 10:e579-e584. [PMID: 35303467 PMCID: PMC8923676 DOI: 10.1016/s2214-109x(22)00031-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 01/19/2023]
Abstract
The COVID-19 pandemic has underscored the need to strengthen national surveillance systems to protect a globally connected world. In low-income and middle-income countries, zoonotic disease surveillance has advanced considerably in the past two decades. However, surveillance efforts often prioritise urban and adjacent rural communities. Communities in remote rural areas have had far less support despite having routine exposure to zoonotic diseases due to frequent contact with domestic and wild animals, and restricted access to health care. Limited disease surveillance in remote rural areas is a crucial gap in global health security. Although this point has been made in the past, practical solutions on how to implement surveillance efficiently in these resource-limited and logistically challenging settings have yet to be discussed. We highlight why investing in disease surveillance in remote rural areas of low-income and middle-income countries will benefit the global community and review current approaches. Using semi-arid regions in Kenya as a case study, we provide a practical approach by which surveillance in remote rural areas can be strengthened and integrated into existing systems. This Viewpoint represents a transition from simply highlighting the need for a more holistic approach to disease surveillance to a solid plan for how this outcome might be achieved.
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Affiliation(s)
| | - Jeff B Bender
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Sharon L Deem
- Institute for Conservation Medicine, Saint Louis Zoo, Saint Louis, MO, USA
| | - Adam W Ferguson
- Gantz Family Collection Center, Field Museum of Natural History, Chicago, IL, USA
| | - Eric M Fèvre
- International Livestock Research Institute, Nairobi, Kenya; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Dino J Martins
- Mpala Research Centre, Nanyuki, Kenya; Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
| | - Dishon M Muloi
- International Livestock Research Institute, Nairobi, Kenya; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Suzan Murray
- Global Health Program, Smithsonian's National Zoo and Conservation Biology Institute, Washington, DC, USA
| | - Mathew Mutinda
- Veterinary Services Department, Kenya Wildlife Service, Nairobi, Kenya
| | - Darcy Ogada
- The Peregrine Fund, Boise, ID, USA; National Museums of Kenya, Nairobi, Kenya
| | - George P Omondi
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, USA; Ahadi Veterinary Resource Center, Nairobi, Kenya
| | - Shailendra Prasad
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, USA
| | - Hannah Wild
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Dawn M Zimmerman
- Department of Clinical Studies, University of Nairobi, Nairobi, Kenya; Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT, USA
| | - James M Hassell
- Global Health Program, Smithsonian's National Zoo and Conservation Biology Institute, Washington, DC, USA; Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT, USA
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George J, Häsler B, Komba EVG, Sindato C, Rweyemamu M, Kimera SI, Mlangwa JED. Leveraging Sub-national Collaboration and Influence for Improving Animal Health Surveillance and Response: A Stakeholder Mapping in Tanzania. Front Vet Sci 2021; 8:738888. [PMID: 34966802 PMCID: PMC8710487 DOI: 10.3389/fvets.2021.738888] [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: 07/09/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Animal health surveillance plays a vital role in ensuring public health, animal welfare, and sustainable food production by monitoring disease trends, early detecting (new) hazards, facilitating disease control and infection, and providing data for risk analysis. Good stakeholder collaboration across the sector can lead to better communication, better science and decision-making and more effective surveillance and response. An understanding of relevant stakeholders, their interests and their power can facilitate such collaboration. While information on key stakeholders in animal health surveillance is available at the national level in Tanzania, it is missing at the subnational level. The study aimed to explore the existing stakeholders' collaborations and influences at the subnational level through stakeholder mapping and to determine potential leverage points for improving the national animal health surveillance system. A qualitative design was used, involving consultative workshops with government animal health practitioners in Sumbawanga, Sikonge and Kilombero districts of Tanzania from December 2020 to January 2021. Data were collected using an adapted USAID stakeholder collaboration mapping tool with the following steps: (i) Define the objective (ii) Identify all stakeholders (iii) Take stock of the current relationships (iv) Determine resource-based influence (v) Determine non-resource based influence and (vi) Review and revise the collaboration map. Forty-five stakeholders were identified in all three districts and grouped into four categories: private sector and non-government organizations (n = 16), government (n = 16), community (n = 9) and political leaders (n = 4). Animal health practitioners had a stronger relationship with community stakeholders as compared to other categories. The results also showed that most of the stakeholders have non-resource-based influence compared to resource-based influence. The private sector and non-government organizations have a relatively higher number of resource-based influential stakeholders, while political leaders have more non-resource-based influence. The mapping exercise demonstrated that the system could benefit from community mobilization and sensitization, resource mobilization and expanding the horizon of surveillance data sources. Some of the leverage points include integration of surveillance activities into animal health services, clear operational processes, constant engagement, coordination and incentivization of stakeholders. The diversity in the identified stakeholders across the districts suggests that collaborations are contextual and socially constructed.
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Affiliation(s)
- Janeth George
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania.,SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Barbara Häsler
- Department of Pathobiology and Population Sciences, Veterinary Epidemiology, Economics, and Public Health Group, Royal Veterinary College, Hatfield, United Kingdom
| | - Erick V G Komba
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Calvin Sindato
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania.,National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania
| | - Mark Rweyemamu
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Sharadhuli I Kimera
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - James E D Mlangwa
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
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Abakar MF, Seli D, Lechthaler F, Crump L, Mancus A, Tran N, Zinsstag J, Muñoz DC. Evaluation of the feasibility and sustainability of the joint human and animal vaccination and its integration to the public health system in the Danamadji health district, Chad. Health Res Policy Syst 2021; 19:44. [PMID: 34380491 PMCID: PMC8356365 DOI: 10.1186/s12961-021-00688-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND One Health approaches such as the Joint human and animal vaccination programmes (JHAVP) are shown to be feasible and to increase health care access to hard-to-reach communities such as mobile pastoralists. However, the financial sustainability and the integration into the public health systems at the district level of such programmes are still challenging. The main objective of the present study was to give insight to the feasibility and financial sustainability of JHAVP integrated as part of the public health system in Chad. METHODS We conducted a mixed methods study using semi-structured key informant interviews, focus group discussions and budget impact analysis. Strengths, weaknesses, opportunities, and threats were analysed regarding the feasibility and sustainability of the implementation of JHAVP in Danamadji health district in Chad. Feasibility was further analysed using three dimensions: acceptability, implementation, and adaptation. Financial sustainability of JHAVP was analysed through budget impact analysis of implementation of the programme at district level. RESULTS The acceptability of this approach was regularly assessed by immunization campaign teams through evaluation meetings which included pastoralists. The presence of authorities in the meetings and workshops of the programme had an incentive effect since they represent a mark of consideration these populations generally declared to be lacking. The coordination between the public health and veterinary services at central and decentralized level seemed to be a key element in the success of the implementation of the programme. Regarding financial sustainability, the total incremental budget impact was 27% slightly decreasing to 26% after five years, which accounts for up to one third of the total budget of the district health office. Also, given that most of the costs for each round are recurrent costs, efficiency gains from scale effects over time are limited. CONCLUSION Based on these findings, we conclude that for JHAVP to be routinely delivered at the district health level, a considerable increase in financial resources would be required. The district could benefit from joint immunization to maintain contact with mobile pastoralists to promote the use of available immunization services at district level.
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Affiliation(s)
- Mahamat Fayiz Abakar
- Institut de Recherche en Elevage pour le Développement, P.O Box 433, N'Djamena, Chad.
- Swiss Tropical and Public Health Institute (Swiss TPH), CH-4002, Basel, Switzerland.
- University of Basel, Petersplatz 1, CH 4001, Basel, Switzerland.
| | - Djimet Seli
- Centre de Recherche en Anthropologie et Sciences Humaines, P.O. Box 6542, N'Djamena, Chad
| | - Filippo Lechthaler
- School of Agricultural, Forest and Food Sciences, Bern University of Applied Sciences, P.O. Box 3052, Zollikofen, Switzerland
| | - Lisa Crump
- Swiss Tropical and Public Health Institute (Swiss TPH), CH-4002, Basel, Switzerland
- University of Basel, Petersplatz 1, CH 4001, Basel, Switzerland
| | | | - Nhan Tran
- World Health Organization, Geneva, Switzerland
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute (Swiss TPH), CH-4002, Basel, Switzerland
- University of Basel, Petersplatz 1, CH 4001, Basel, Switzerland
| | - Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute (Swiss TPH), CH-4002, Basel, Switzerland
- University of Basel, Petersplatz 1, CH 4001, Basel, Switzerland
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Prosser C, Gresty K, Ellis J, Meyer W, Anderson K, Lee R, Cheng Q. Plasmodium falciparum Histidine-Rich Protein 2 and 3 Gene Deletions in Strains from Nigeria, Sudan, and South Sudan. Emerg Infect Dis 2021; 27:471-479. [PMID: 33496220 PMCID: PMC7853540 DOI: 10.3201/eid2702.191410] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Deletion of histidine-rich protein genes pfhrp2/3 in Plasmodium falciparum causes infections to go undetected by HRP2-based malaria rapid diagnostic tests. We analyzed P. falciparum malaria cases imported to Australia (n = 210, collected 2010–2018) for their pfhrp2/3 status. We detected gene deletions in patients from 12 of 25 countries. We found >10% pfhrp2-deletion levels in those from Nigeria (13.3%, n = 30), Sudan (11.2%, n = 39), and South Sudan (17.7%, n = 17) and low levels of pfhrp3 deletion from Sudan (3.6%) and South Sudan (5.9%). No parasites with pfhrp2/3 double deletions were detected. Microsatellite typing of parasites from Nigeria, Sudan, and South Sudan revealed low relatedness among gene-deleted parasites, indicating independent emergences. The gene deletion proportions signify a risk of false-negative HRP2-RDT results. This study’s findings warrant surveillance to determine whether the prevalence of gene-deleted parasites justifies switching malaria rapid diagnostic tests in Nigeria, Sudan, and South Sudan.
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Sangare M, Coulibaly YI, Coulibaly SY, Dolo H, Diabate AF, Atsou KM, Souleymane AA, Rissa YA, Moussa DW, Abdallah FW, Dembele M, Traore M, Diarra T, Brieger WR, Traore SF, Doumbia S, Diop S. Factors hindering health care delivery in nomadic communities: a cross-sectional study in Timbuktu, Mali. BMC Public Health 2021; 21:421. [PMID: 33639923 PMCID: PMC7916290 DOI: 10.1186/s12889-021-10481-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 02/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations’ characteristics, determine their perception on the current health services, and identify issues associated with community-based health interventions. Methods To develop a better health policy and strategic approaches adapted to nomadic populations, we conducted a cross-sectional study in the region of Timbuktu to describe the difficulties in accessing health services. The study consisted in administering questionnaires to community members in the communes of Ber and Gossi, in the Timbuktu region, to understand their perceptions of health services delivery in their settings. Results We interviewed 520 individuals, all members of the nomadic communities of the two study communes. Their median age was 38 years old with extremes ranging from 18 to 86 years old. Their main activities were livestock breeding (27%), housekeeping (26.4%), local trading (11%), farming (6%) and artisans (5.5%). The average distance to the local health center was 40.94 km and 23.19 km respectively in Gossi and Ber. In terms of barriers to access to health care, participants complained mainly about the transportation options (79.4%), the quality of provided services (39.2%) and the high cost of available health services (35.7%). Additionally, more than a quarter of our participants stated that they would not allow themselves to be examined by a health care worker of the opposite gender. Conclusion This study shows that nomadic populations do not have access to community-based health interventions. A number of factors were revealed to be important barriers per these communities’ perception including the quality of services, poverty, lifestyle, gender and current health policy strategies in the region. To be successful, future interventions should take these factors into account by adapting policies and methods. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10481-w.
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Affiliation(s)
- Moussa Sangare
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali. .,Interdisciplinary School of Health Sciences
- Faculty of Health Sciences, University of Ottawa, 75, av. Laurier Est, Ottawa ON K1N 6N5, Canada.
| | - Yaya Ibrahim Coulibaly
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Siaka Yamoussa Coulibaly
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Housseini Dolo
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Abdoul Fatao Diabate
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Kueshivi Midodji Atsou
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Abdoul Ag Souleymane
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Youssouf Ag Rissa
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Dada Wallet Moussa
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Fadimata Wallet Abdallah
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Massitan Dembele
- General Directorate of Health and Public Hygiene, Ministry of Health and Social Affairs of Mali, Bamako, Mali
| | - Mahamadou Traore
- General Directorate of Health and Public Hygiene, Ministry of Health and Social Affairs of Mali, Bamako, Mali
| | - Tieman Diarra
- World Health Organization (WHO), Regional Office for Africa, Cite du Djoue, PO Box 06, Brazzaville, Congo
| | - William R Brieger
- Department of International Health, Health System Program, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Sekou Fantamady Traore
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Seydou Doumbia
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Samba Diop
- Mali International Center for Excellence in Research (ICER), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
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Wild H, Mendonsa E, Trautwein M, Edwards J, Jowell A, GebreGiorgis Kidanu A, Tschopp R, Barry M. Health interventions among mobile pastoralists: a systematic review to guide health service design. Trop Med Int Health 2020; 25:1332-1352. [PMID: 32881232 DOI: 10.1111/tmi.13481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap. METHODS We conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records. RESULTS Our search yielded 4884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11). CONCLUSION Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and 'temporary fixed' services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.
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Affiliation(s)
- Hannah Wild
- Stanford University School of Medicine, Stanford, CA, USA.,Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Micah Trautwein
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | - Ashley Jowell
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Rea Tschopp
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Michele Barry
- Stanford University School of Medicine, Stanford, CA, USA.,The Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
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Molyneux DH, Aboe A, Isiyaku S, Bush S. COVID-19 and neglected tropical diseases in Africa: impacts, interactions, consequences. Int Health 2020; 12:367-372. [PMID: 32725145 PMCID: PMC7443717 DOI: 10.1093/inthealth/ihaa040] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/22/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- David H Molyneux
- Emeritus Professor, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Agatha Aboe
- Global Trachoma Coordinator, Sightsavers, PO Box KIA 18190, Airport, Accra, Ghana
| | - Sunday Isiyaku
- Country Director Ghana and Nigeria, Sightsavers, 1 Golf Course Road, Kaduna, Nigeria
| | - Simon Bush
- Director, Neglected Tropical Diseases, Sightsavers, PO Box KIA 18190, Airport, Accra, Ghana
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