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Matji R, Maama L, Roscigno G, Lerotholi M, Agonafir M, Sekibira R, Law I, Tadolini M, Kak N. Policy and programmatic directions for the Lesotho tuberculosis programme: Findings of the national tuberculosis prevalence survey, 2019. PLoS One 2023; 18:e0273245. [PMID: 36893175 PMCID: PMC9997977 DOI: 10.1371/journal.pone.0273245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/04/2022] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION The Kingdom of Lesotho has one of the highest burdens of tuberculosis (TB) in the world. A national TB prevalence survey was conducted to estimate the prevalence of bacteriologically confirmed pulmonary TB disease among those ≥15 years of age in 2019. METHOD A multistage cluster-based cross-sectional survey where residents ≥15 years in 54 clusters sampled from across the country were eligible to participate. Survey participants were screened using a symptom screen questionnaire and digital chest X-ray (CXR). Respondents who acknowledged cough of any duration, fever, weight loss, night sweats and/or had any CXR abnormality in the lungs were asked to provide two spot sputum specimens. All sputum testing was conducted at the National TB Reference Laboratory (NTRL), where samples underwent Xpert MTB/RIF Ultra (1st sample) and MGIT culture (2nd sample). HIV counselling and testing was offered to all survey participants. TB cases were those with Mycobacterium tuberculosis complex-positive samples with culture; and where culture was not positive, Xpert MTB/RIF Ultra (Xpert Ultra) was positive with a CXR suggestive of active TB and no current or prior history of TB. RESULT A total of 39,902 individuals were enumerated, and of these, 26,857 (67.3%) were eligible to participate; 21,719 (80.9%) participated in the survey of which 8,599 (40%) were males and 13,120 (60%) were females. All 21,719 (100%) survey participants underwent symptom screening and a total of 21,344 participants (98.3%) had a CXR. Of the 7,584 (34.9%) participants who were eligible for sputum examination, 4,190 (55.2%) were eligible by CXR only, 1,455 (19.2%) by symptom screening, 1,630 by both, and 309 by CXR exemption. A total of 6,780 (89.4%) submitted two sputum specimens, and 311 (4.1%) submitted one sample only. From the 21,719 survey participants, HIV counseling and testing was offered to 17,048, and 3,915 (23.0%) were documented as HIV-positive. The survey identified 132 participants with bacteriologically confirmed pulmonary TB thus providing an estimated prevalence of 581 per 100,000 population (95% CI 466-696) for those ≥15 years in 2019. Using the survey results, TB incidence was re-estimated to be 654 per 100,000 (95% CI 406-959), which was comparable to the 2018 TB incidence rate of 611 per 100,000 (95% CI 395-872) reported by the World Health Organization (WHO). The highest TB burden was found in those ≥55 years and among men. The ratio of prevalence to case notification was estimated at 1.22. TB/HIV coinfection was identified in 39 (29.6%) participants. Out of the 1,825 participants who reported a cough, 50% of these participants, mostly men, did not seek care. Those who sought care predominantly went to the public health facilities. CONCLUSION The TB prevalence survey results confirmed that burden of TB and TB/HIV coinfection remains very high in Lesotho. Given that TB prevalence remains high, and there is a significant proportion of participants with confirmed TB that did not report TB suggestive symptoms. The National TB Programme will need to update its TB screening and treatment algorithms to achieve the End TB targets. A major focus will need to be placed on finding the "missing cases" i.e., undiagnosed or under-reported TB cases, or ensuring that not only TB symptomatic but also those who do not present with typical TB symptoms are promptly identified to reduce further onward transmission.
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Affiliation(s)
- R. Matji
- AQUITY Innovations, Pretoria, South Africa
| | - L. Maama
- Ministry of Health, Maseru, Lesotho
| | | | | | | | | | - I. Law
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - M. Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - N. Kak
- AQUITY Global Inc., Bethesda, Maryland, United States of America
- * E-mail:
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Kheang ST, Ridley R, Ngeth E, Ir P, Ngor P, Sovannaroth S, Lek D, Phon S, Kak N, Yeung S. G6PD testing and radical cure for Plasmodium vivax in Cambodia: A mixed methods implementation study. PLoS One 2022; 17:e0275822. [PMID: 36264996 PMCID: PMC9584508 DOI: 10.1371/journal.pone.0275822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Cambodia aims to eliminate malaria by 2025, however tackling Plasmodium vivax (P.v) presents multiple challenges. The prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency has prevented the deployment of 8-aminoquinolones for “radical cure”, due to the risk of severe haemolysis. Patients with P. vivax have therefore continued to experience recurrent relapses leading to cumulative health and socioeconomic burden. The recent advent of point of care testing for G6PD deficiency has made radical cure a possibility, however at the time of the study lack of operational experience and guidance meant that they had not been introduced. This study therefore aimed to design, implement and evaluate a new care pathway for the radical cure of P.vivax. Methods This implementation study took place in Pursat province, Western Cambodia. The interventions were co-developed with key stakeholders at the national, district, and local level, through a continuous process of consultations as well as formal meetings. Mixed methods were used to evaluate the feasibility of the intervention including its uptake (G6PD testing rate and the initiation of primaquine treatment according to G6PD status); adherence (self-reported); and acceptability, using quantitative analysis of primary and secondary data as well as focus group discussions and key informant interviews. Results The co-development process resulted in the design of a new care pathway with supporting interventions, and a phased approach to their implementation. Patients diagnosed with P.v infection by Village Malaria Workers (VMWs) were referred to local health centres for point-of-care G6PD testing and initiation of radical cure treatment with 14-day or 8-week primaquine regimens depending on G6PD status. VMWs carried out follow-up in the community on days 3, 7 and 14. Supporting interventions included training, community sensitisation, and the development of a smartphone and tablet application to aid referral, follow-up and surveillance. The testing rate was low initially but increased rapidly over time, reflecting the deliberately cautious phased approach to implementation. In total 626 adults received G6PD testing, for a total of 675 episodes. Of these 555 occurred in patients with normal G6PD activity and nearly all (549/555, 98.8%) were initiated on PQ14. Of the 120 with deficient/intermediate G6PD activity 61 (50.8%) were initiated on PQ8W. Self-reported adherence was high (100% and 95.1% respectively). No severe adverse events were reported. The pathway was found to be highly acceptable by both staff and patients. The supporting interventions and gradual introduction were critical to success. Challenges included travel to remote areas and mobility of P.v patients. Conclusion The new care pathway with supporting interventions was highly feasible with high levels of uptake, adherence and acceptability in this setting where high prevalence of G6PD deficiency is high and there is a well-established network of VMWs. Scaling up of the P.v radical cure programme is currently underway in Cambodia and a decline in reduction in the burden of malaria is being seen, bringing Cambodia a step closer to elimination.
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Affiliation(s)
- Soy Ty Kheang
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
- National Institute of Public Health (NIPH), Phnom Penh, Cambodia
| | - Rosemarie Ridley
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Eng Ngeth
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
| | - Por Ir
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
- National Institute of Public Health (NIPH), Phnom Penh, Cambodia
| | - Pengby Ngor
- National Malaria Control Program, The National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Siv Sovannaroth
- National Malaria Control Program, The National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Dysoley Lek
- National Malaria Control Program, The National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Somaly Phon
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
| | - Neeraj Kak
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- * E-mail:
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Kheang ST, Por I, Sovannaroth S, Dysoley L, Chea H, Po L, AlMossawi HJ, Imran AA, Kak N. Cambodia malaria indicator survey 2020: Implications for malaria elimination. Malariaworld J 2021; 12:5. [PMID: 34532228 PMCID: PMC8415051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cambodia has made significant progress in controlling malaria in the past decade. It now aims to eliminate malaria from the country by 2025. It launched the Malaria Elimination Action Framework (MEAF 2016-2020) in 2015 with strong political commitment targeting appropriate interventions on high-risk populations, particularly mobile and migrant groups. METHODS In 2020, the household-level Cambodia Malaria Survey 2020 (CMS 2020) was conducted with the objective to assess the performance of malaria control activities using the indicators outlined in MEAF 2016-2020. The survey used a cross-sectional probability proportional to size approach drawing 4,000 households from 100 villages across the malaria-endemic districts of the country. RESULTS A total of 3,996 households with 17,415 inhabitants were interviewed. Of the surveyed households, 98.4% owned a long-lasting insecticide-treated bednet or hammock (LLIN/LLIHN). However, only 79.5% of these reported sleeping under a net the previous night, with only 45.7% sleeping under an insecticide treated net (ITN). Given that forest visitors are at the highest risk of getting malaria, the survey also targeted this group. Of the forest visitor respondents, 89.3% brought an ITN along and 88.9% reported to have used a net during their forest stay. About 10.8% of forest goers had received a forest kit for malaria prevention from mobile malaria workers the last time they went to the forest. Knowledge about mosquito repellents was high among forest goers (62.5%) but the actual use thereof during the last visit to the forest was low (22%). While awareness about malaria prevention with LLINs remained high among most respondents, knowledge about malaria diagnosis and treatment was not universal. Source of malaria knowledge and its treatment was usually from a household member, followed by a village malaria worker or a primary health care center staff. Of those who had fever during the previous two weeks, 93.6% sought advice or treatment outside the home, and the most commonly reported source for advice or treatment was private providers (39.4%) followed by health center/district hospital (31.3%). CONCLUSIONS ITN distribution and other malaria prevention interventions have largely benefited the high-risk groups including the forest visitors. Comparing the CMS 2020 results with the 2017 CMS results, it is clear that forest visitors' use of LLIN/LLIHN has improved considerably. However, more needs to be done to ensure forest visitors be protected either through using LLINs or repellents while working and staying in the forest areas. Also, given that sleeping under LLINs has decreased over the past several years among the at-risk populations, the programme will have to develop strategies to ensure that the communities do not lower their guard against malaria as cases further dwindle in malaria prone areas. Heightened awareness amongst the general population will be critical for eliminating malaria in Cambodia without any possibility of malaria re-emergence or re-establishment.
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Affiliation(s)
- Soy T. Kheang
- Health and Social Development (HSD), Cambodia
- National Institute of Public Health (NIPH), Cambodia
| | - Ir Por
- National Institute of Public Health (NIPH), Cambodia
| | | | - Lek Dysoley
- National Malaria Control Program (CNM), Cambodia
| | - Huch Chea
- National Malaria Control Program (CNM), Cambodia
| | - Ly Po
- National Malaria Control Program (CNM), Cambodia
| | | | - Abu Al Imran
- Health and Social Development (HSD), Cambodia
- AQUITY Global Inc., (AGI) USA
| | - Neeraj Kak
- Health and Social Development (HSD), Cambodia
- AQUITY Global Inc., (AGI) USA
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Moran A, Mphahlele M, Mvusi L, Dlamini C, Ahmedov S, AlMossawi HJ, Kak N. Learning from tuberculosis: COVID-19 highlights the need for more robust infection control policy. J Glob Health 2020; 10:020328. [PMID: 33110528 PMCID: PMC7561217 DOI: 10.7189/jogh.10.020328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alexander Moran
- University Research Co., LLC (URC), Center for Innovation and Technology, Chevy Chase, Maryland, USA
| | - Matsie Mphahlele
- University Research Co., LLC (URC), USAID Tuberculosis South Africa Project, Pretoria, Gauteng, South Africa
| | - Lindiwe Mvusi
- National Department of Health, Pretoria, Gauteng, South Africa
| | - Cindy Dlamini
- United States Agency for International Development (USAID), Pretoria, Gauteng, South Africa
| | - Sevim Ahmedov
- United States Agency for International Development (USAID), Washington, D. C., USA
| | - Hala Jassim AlMossawi
- University Research Co., LLC (URC), Center for Innovation and Technology, Chevy Chase, Maryland, USA
| | - Neeraj Kak
- University Research Co., LLC (URC), Center for Innovation and Technology, Chevy Chase, Maryland, USA
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Moran A, Kula N, Jagwer G, Broughton E, Pillay Y, Mvusi L, AlMossawi H, Ndjeka N, Mametja D, Dlamini C, Ahmedov S, Matji R, Kak N. Examining the cost of community-based tuberculosis treatment in South Africa. Int J Tuberc Lung Dis 2020; 24:612-618. [PMID: 32552992 DOI: 10.5588/ijtld.19.0552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: While South Africa has improved access to tuberculosis (TB) treatment and care, the 2015 treatment success rate for multidrug-resistant TB (MDR-TB) remains low, at 55%. Community-based TB treatment and care improves patient retention compared to the standard of care alone.OBJECTIVE: To assess the cost of a USAID-funded community-based TB model in Nelson Mandela Bay Health District (NMBHD), Eastern Cape Province, South Africa compared to the national standard of care alone.DESIGN: We estimated the cost of community-based DR-TB treatment and adherence support compared to the standard of care alone.RESULTS: Average overall costs were US$2827 lower per patient on the community-based model than the standard of care alone.CONCLUSION: The per-patient cost of the community-based model is lower than the standard of care alone. Assuming the costs and effects of a community-based model implemented in NMBHD were observed at a larger scale, implementing the model could reduce overall health system costs.
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Affiliation(s)
- A Moran
- University Research Co (URC), Chevy Chase, MD, USA
| | | | | | - E Broughton
- University Research Co (URC), Chevy Chase, MD, USA
| | - Y Pillay
- National Department of Health, Pretoria, Gauteng
| | - L Mvusi
- National Department of Health, Pretoria, Gauteng
| | - H AlMossawi
- University Research Co (URC), Chevy Chase, MD, USA
| | - N Ndjeka
- National Department of Health, Pretoria, Gauteng
| | - D Mametja
- National Department of Health, Pretoria, Gauteng
| | - C Dlamini
- United States Agency for International Development (USAID), Pretoria, Gauteng, South Africa
| | | | | | - N Kak
- University Research Co (URC), Chevy Chase, MD, USA
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Kak N, Chakraborty K, Sadaphal S, AlMossawi HJ, Calnan M, Vikarunnessa B. Strategic priorities for TB control in Bangladesh, Indonesia, and the Philippines - comparative analysis of national TB prevalence surveys. BMC Public Health 2020; 20:560. [PMID: 32334545 PMCID: PMC7183625 DOI: 10.1186/s12889-020-08675-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background Philippines, Indonesia, and Bangladesh are three high tuberculosis (TB) burden countries in Asia which account for 18% of the estimated global TB incidence (1.8 million) and 15% of TB related deaths (192,000). In 2017 alone, approximately 785,000 of the incident TB cases in these countries remained missing, including diagnosed but not notified. Methods We reviewed the published data from the most recent TB prevalence surveys conducted in Bangladesh, Indonesia, and the Philippines. The prevalence rates established by the surveys were used to estimate the disease burden of these countries for 2017. The Global TB Report 2017 and World Health Organization’s (WHO) global TB database were sourced for collection of incidence and notification data by age groups and types of TB to estimate prevalence to notification gaps 2017. Results According to the surveys, the estimated prevalence rates of bacteriologically confirmed TB and smear-positive TB are 287 and 113 for Bangladesh (2015–16), 759 and 256 for Indonesia (2013–14) and 1159 and 434 for the Philippines (2016) per 100,000 population over the age of 15 years. The overall national TB prevalence estimates for all forms is 260 for Bangladesh, 660 for Indonesia, and 970 for the Philippines (2016). Compared with the incidence rate, the proportion of total notified cases is 67% for Bangladesh, 52% for Indonesia, and 55% for the Philippines. Bangladesh has been able to detect almost 100% of the prevalent pulmonary TB, while Indonesia and Philippines have detected only 30 and 22% of these infectious cases respectively. Although notification has been improving over the years, there is no impact on the incidence rate since a large proportion of the undiagnosed cases, and delayed diagnosis continue to feed the transmission process. Conclusion The surveys have provided data that is critical for developing realistic strategies for these countries to eliminate TB. In general, this paper recommends interventions for strengthening diagnosis of pulmonary TB, implementing targeted communication programs and active case finding to reduce patient level delays, expanding public-private partnership to increase access to TB services, using rapid diagnostics, and providing social protection for vulnerable populations. These measures can accelerate these countries’ progress towards achieving End TB goals.
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Affiliation(s)
- Neeraj Kak
- University Research Co., LLC (URC), Chevy Chase, MD, USA.
| | | | - Swati Sadaphal
- University Research Co., LLC (URC), Chevy Chase, MD, USA
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Kheang ST, Sovannaroth S, Barat LM, Dysoley L, Kapella BK, Po L, Nguon S, Gimnig J, Slot R, Samphornarann T, Meng SK, Dissanayake G, AlMossawi HJ, Longacre C, Kak N. Malaria elimination using the 1-3-7 approach: lessons from Sampov Loun, Cambodia. BMC Public Health 2020; 20:544. [PMID: 32321475 PMCID: PMC7178947 DOI: 10.1186/s12889-020-08634-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Cambodia has targeted malaria elimination within its territory by 2025 and is developing a model elimination package of strategies and interventions designed to achieve this goal. Methods Cambodia adopted a simplified 1-3-7 surveillance model in the Sampov Loun operational health district in western Cambodia beginning in July 2015. The 1-3-7 approach targets reporting of confirmed cases within one day, investigation of specific cases within three days, and targeted control measures to prevent further transmission within seven days. In Sampov Loun, response measures included reactive case detection (testing of co-travelers, household contacts and family members, and surrounding households with suspected malaria cases), and provision of health education, and insecticide-treated nets. Day 28 follow up microscopy was conducted for all confirmed P. falciparum and P. falciparum-mixed-species malaria cases to assess treatment efficacy. Results The number of confirmed malaria cases in the district fell from 519 in 2015 to 181 in 2017, and the annual parasite incidence (API) in the district fell from 3.21 per 1000 population to 1.06 per 1000 population. The last locally transmitted case of malaria in Sampov Loun was identified in March 2016. In response to the 408 index cases identified, 1377 contacts were screened, resulting in the identification of 14 positive cases. All positive cases occurred among index case co-travelers. Conclusion The experience of the 1-3-7 approach in Sampov Loun indicates that the basic essential malaria elimination package can be feasibly implemented at the operational district level to achieve the goal of malaria elimination in Cambodia and has provided essential information that has led to the refinement of this package.
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Affiliation(s)
| | | | - Lawrence M Barat
- President's Malaria Initiative/United States Agency for International Development, Washington, DC, USA
| | - Lek Dysoley
- National Malaria Control Program, Phnom Penh, Cambodia
| | - Bryan K Kapella
- President's Malaria Initiative/Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ly Po
- National Malaria Control Program, Phnom Penh, Cambodia
| | | | - John Gimnig
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rida Slot
- President's Malaria Initiative/United States Agency for International Development, Phnom Penh, Cambodia
| | | | | | - Gunawardena Dissanayake
- President's Malaria Initiative/United States Agency for International Development, Phnom Penh, Cambodia
| | | | | | - Neeraj Kak
- University Research Co., LLC, Chevy Chase, MD, USA.
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Por I, Sovannaroth S, Moran A, Dysoley L, Nguon S, Bunthy O, Meas MS, Barat L, Slot R, Thangadurai S, Kapella BK, Hassan SED, Po L, An SS, Gimnig JE, McDowell M, Thigpen M, Armistead J, AlMossawi HJ, Kheang ST, Kak N. Cost-effectiveness of malaria elimination in Sampov Loun Operational District, Cambodia. Malariaworld J 2020; 11:2. [PMID: 34532221 PMCID: PMC8415074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Over the past decade, Cambodia has seen a significant decline in its malaria burden. The government has established the goal of eliminating malaria in the country by 2025. With PMI/USAID support, Cambodia is implementing a package of interventions as part of its efforts. This assessment aimed to describe the cost of malaria elimination activities in Sampov Loun Operational District (OD) between July 2015 and March 2018, to describe the cost per malaria case detected under PMI programming, and to estimate the incremental cost-effectiveness of the elimination programme per Plasmodium falciparum (Pf) or P. vivax (Pv)/Pf mixed case averted under the Cambodia Malaria Elimination Programme (CMEP) and the U.S. President's Malaria Initiative. Opportunity costs of government workers were also assessed to understand the theoretical cost of sustaining this programme through government efforts alone. MATERIALS AND METHODS We conducted an empirical micro-costing analysis based on elimination activities alone using CMEP internal project implementation data and corresponding epidemiologic data from July 2015 to March 2018 and empirical findings from implementation to date. We then constructed a cost model in Microsoft Excel using empirical data and used a cost-effectiveness decision tree to describe programme effectiveness in the first three years of implementation and to estimate efficacy for the subsequent year. RESULTS The total cost of malaria elimination activities in Sampov Loun OD from July 2015 to March 2018 was $883,096. The cost per case of malaria detected in 2017 was $1,304. Including opportunity costs for government staff from July 2015 to March 2018, the total cost was $926,000. Under continued CMEP implementation, the projected future total cost of the program would be about $110,000 per year, or $0.64 per Sampov Loun resident. The incremental cost-effectiveness of the elimination programme was $28 for every additional Pf or Pv/Pf mix malaria case averted, compared to the no-CMEP proxy. CONCLUSION CMEP activities are cost effective compared to the no-CMEP proxy, as shown through an incremental cost-effectiveness of $28 for every additional Pf or Pv/Pf mix malaria case averted. The total cost of the project is 0.93% of the total per capita spending on health in Cambodia and about 5% of all government health expenditure. Continuing investments in malaria will be needed at national level for stewardship and governance and at local level for ensuring programme readiness in case of malaria outbreaks.
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Affiliation(s)
- Ir Por
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | | | - Lek Dysoley
- National Malaria Control Program, Phnom Penh, Cambodia
| | - Sokomar Nguon
- PMI/USAID Cambodia Malaria Elimination Project, Phnom Penh, Cambodia
| | - Om Bunthy
- Sampov Loun Operational District, Battambang Province, Cambodia
| | - May Sak Meas
- Sampov Loun Operational District, Battambang Province, Cambodia
| | - Lawrence Barat
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Rida Slot
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | | | - Bryan K. Kapella
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Saad El-Din Hassan
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Ly Po
- National Malaria Control Program, Phnom Penh, Cambodia
| | - Sen Sam An
- PMI/USAID Cambodia Malaria Elimination Project, Phnom Penh, Cambodia
| | - John E. Gimnig
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Mary McDowell
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Michael Thigpen
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | - Jennifer Armistead
- US President’s Malaria Initiative, United States Agency for International Development,Washington DC, USA
| | | | - Soy Ty Kheang
- National Institute of Public Health, Phnom Penh, Cambodia;,PMI/USAID Cambodia Malaria Elimination Project, Phnom Penh, Cambodia
| | - Neeraj Kak
- University Research Co., LLC (URC), Chevy Chase, MD, USA;,*
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Le H, Nguyen N, Tran P, Hoa N, Hung N, Moran A, Mossawi HJA, Kak N, Ahmedov S, Brooks MB, Nardell EA, Tierney DB. Process measure of FAST tuberculosis infection control demonstrates delay in likely effective treatment. Int J Tuberc Lung Dis 2019; 23:140-146. [PMID: 30621813 DOI: 10.5588/ijtld.18.0268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The tuberculous infection control strategy, FAST (Find cases Actively, Separate safely and Treat effectively), recommends prompt initiation of likely effective anti-tuberculosis treatment informed by Xpert® MTB/RIF results.OBJECTIVE: To describe FAST implementation at Quang Nam Provincial TB and Lung Disease Hospital (QNH), Tam Ky, Viet Nam, using time to initiation of effective TB treatment as a process measure. DESIGN Hospital logs were used to calculate the time to likely effective treatment in patients with pulmonary TB (PTB) hospitalised during the study period. RESULTS Between 1 January and 31 December 2016, of 858 patients treated for PTB, 493 (57.5%) received likely effective treatment. The median time to likely effective treatment was 3 days (interquartile range 2.0-6.0), with 213 (43.2%) patients receiving likely effective treatment within 2 days. Of 81 patients receiving likely effective treatment for drug-susceptible TB with a positive Xpert result as their initial in-patient diagnostic test, 64 (79.0%) received likely effective treatment within 2 days compared with 10 (5.7%) who were initially smear-negative then found to be Xpert-positive (P < 0.0001). CONCLUSIONS A 'time to' process measure of the FAST tuberculous infection control strategy indicates delays in the initiation of likely effective anti-tuberculosis treatment in a resource-limited hospital. Expanding access to Xpert may speed time to likely effective treatment.
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Affiliation(s)
- H Le
- University Research Co, LLC, Hanoi
| | - N Nguyen
- National Lung Hospital/National TB Program, Hanoi
| | - P Tran
- Pham Ngoc Thach Hospital, Quang Nam, Viet Nam
| | - N Hoa
- National Lung Hospital/National TB Program, Hanoi, Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - N Hung
- National Lung Hospital/National TB Program, Hanoi
| | - A Moran
- University Research Co, LLC, Chevy Chase, Maryland
| | | | - N Kak
- University Research Co, LLC, Chevy Chase, Maryland
| | - S Ahmedov
- United States Agency for International Development, Washington, DC
| | - M B Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - E A Nardell
- Division of Global Health Equity, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - D B Tierney
- Division of Global Health Equity, Brigham & Women's Hospital, Boston, Massachusetts, USA
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10
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Daru P, Matji R, AlMossawi HJ, Chakraborty K, Kak N. Decentralized, Community-Based Treatment for Drug-Resistant Tuberculosis: Bangladesh Program Experience. Glob Health Sci Pract 2018; 6:594-602. [PMID: 30287534 PMCID: PMC6172109 DOI: 10.9745/ghsp-d-17-00345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 08/14/2018] [Indexed: 11/29/2022]
Abstract
Shifting from hospital- to community-based management of drug-resistant TB, increased treatment enrollment, reduced treatment initiation delays, improved follow-up and adherence, and lowered treatment failure, and was associated with higher cure rates and lower mortality. Background: Bangladesh is a highly populous country where the prevalence of drug-resistant tuberculosis (DR-TB) is growing. With the rapid increase in DR-TB notifications through GeneXpert technology, it was imperative to come up with a new treatment strategy that could keep up with the increase of patients diagnosed. Intervention: Intervention was designed to support national transition of DR-TB management of World Health Organization-approved long course (20-to-24-month regimen) treatment from a hospital-based approach to the decentralized model of community-based programmatic management of DR-TB (cPMDT). In close coordination with the Ministry of Health and Family Welfare and National TB Program, patients were initiated into treatment at hospitals and then transferred to community-based care. A cadre of directly observed therapy providers supported treatment at the household level, supervised by the outpatient DR-TB teams. Methods: We conducted a descriptive pre- and post-intervention study of all 1,946 DR-TB patients enrolled in treatment nationwide between May 2012 and June 2015. Data were collected from hospitals, patient cards, district records, and diagnostic laboratories through the National TB Program. Intervention results were assessed in comparison with the baseline (2011) indicators. Results: During the intervention period, treatment enrollment of 1,946 diagnosed DR-TB patients through the national program increased from 50% in 2011 to 100% in 2015. The delay between diagnosis and treatment initiation decreased from 69 days in 2011 to 6 days in 2014. Most (95%) of the patients completed all scheduled follow-up smear and culture tests. By the sixth month of treatment, 99% of patients had negative smear conversion and 98% had negative culture conversion. The treatment success rate increased from 70% in 2011 to 76% in 2015 at the end of the intervention period. The results also indicate a decline between baseline and end line from 34% to 9% for patients died, 34% to 10% for loss to follow-up, and 1.7% to 0% for treatment failure. Conclusions: Community-based management is an effective approach for increasing access to quality-assured DR-TB treatment. Using existing structures and resources, the intervention demonstrated that favorable treatment outcomes can be achieved and sustained by treating patients with DR-TB at their homes.
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Affiliation(s)
- Paul Daru
- University Research Co., LLC, Dhaka, Bangladesh
| | | | | | | | - Neeraj Kak
- University Research Co., LLC, Chevy Chase, MD, USA.
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11
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Kheang ST, Lin MA, Lwin S, Naing YH, Yarzar P, Kak N, Price T. Malaria Case Detection Among Mobile Populations and Migrant Workers in Myanmar: Comparison of 3 Service Delivery Approaches. Glob Health Sci Pract 2018; 6:384-389. [PMID: 29875157 PMCID: PMC6024619 DOI: 10.9745/ghsp-d-17-00318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mobile populations and migrant workers are a key population to containing the spread of artemisinin-resistant malaria found in the border areas between Cambodia, Myanmar, and Thailand. Migrants often have limited knowledge of public health, including malaria, services in the area, and many seek care from unregulated, private vendors. METHODS Between October 2012 and August 2016, we implemented malaria case finding and treatment in Tanintharyi Region, Kayin State, and Rakhine State of Myanmar through 3 entry points: village malaria workers (VMWs), mobile malaria clinics, and screening points. A total of 1,000 VMWs provided passive case detection and treatment services to residents in malaria-endemic villages. Active case finding through mobile malaria clinics was conducted by staff in 354 remote villages and work sites, where regular monitoring and supervision of VMWs would be difficult to maintain. Malaria screening points were a hybrid combination of active and passive case finding in which screening points were set up at fixed locations in Tanintharyi Region and Kayin State, such as bus stops, ferry docks, or informal border crossing points, and migrants entering into or departing from endemic areas could voluntarily receive malaria testing and treatment. Using routine monitoring data, we assessed and compared the malaria positive rate-the number of positive malaria cases out of those tested-across the 3 approaches as an indication of the programmatic effectiveness in identifying malaria cases in the population. Most testing was conducted with rapid diagnostic tests. RESULTS Mobile teams (169,859) and VMWs (157,048) tested a higher number of community members than screening points (3,676) as they covered a wider geographical area. However, the malaria positive rate was higher among VMWs (7.29%) and screening points (7.10%) than mobile teams (2.64%). VMWs were located in hard-to-access areas that have higher malaria prevalence and are difficult to reach by vehicle while screening points specifically targeted mobile populations and migrant workers. Mobile teams also screened non-fever patients during their visits, which may explain their lower malaria positive rate. CONCLUSIONS A combination of malaria testing approaches helps achieve both maximum reach and high case finding as it allows access to a range of migrant communities and provides an opportunity for continuity of service delivery as the migrants travel to their destinations.
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Affiliation(s)
| | | | - Saw Lwin
- University Research Co., LLC, Yangon, Myanmar
| | | | - Phyo Yarzar
- University Research Co., LLC, Yangon, Myanmar
| | - Neeraj Kak
- University Research Co., LLC, Chevy Chase, MD, USA
| | - Taylor Price
- University Research Co., LLC, Chevy Chase, MD, USA
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12
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Nathavitharana RR, Daru P, Barrera AE, Mostofa Kamal SM, Islam S, Ul-Alam M, Sultana R, Rahman M, Hossain MS, Lederer P, Hurwitz S, Chakraborty K, Kak N, Tierney DB, Nardell E. FAST implementation in Bangladesh: high frequency of unsuspected tuberculosis justifies challenges of scale-up. Int J Tuberc Lung Dis 2018; 21:1020-1025. [PMID: 28826452 DOI: 10.5588/ijtld.16.0794] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
SETTING National Institute of Diseases of the Chest and Hospital, Dhaka; Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka; and Chittagong Chest Disease Hospital, Chittagong, Bangladesh. OBJECTIVE To present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a tuberculosis (TB) transmission control strategy. DESIGN FAST was implemented sequentially at three hospitals. RESULTS Using Xpert® MTB/RIF, 733/6028 (12.2%, 95%CI 11.4-13.0) patients were diagnosed with unsuspected TB. Patients with a history of TB who were admitted with other lung diseases had more than twice the odds of being diagnosed with unsuspected TB as those with no history of TB (OR 2.6, 95%CI 2.2-3.0, P < 0.001). Unsuspected multidrug-resistant TB (MDR-TB) was diagnosed in 89/1415 patients (6.3%, 95%CI 5.1-7.7). Patients with unsuspected TB had nearly five times the odds of being diagnosed with MDR-TB than those admitted with a known TB diagnosis (OR 4.9, 95%CI 3.1-7.6, P < 0.001). Implementation challenges include staff shortages, diagnostic failure, supply-chain issues and reliance on external funding. CONCLUSION FAST implementation revealed a high frequency of unsuspected TB in hospitalized patients in Bangladesh. Patients with a previous history of TB have an increased risk of being diagnosed with unsuspected TB. Ensuring financial resources, stakeholder engagement and laboratory capacity are important for sustainability and scalability.
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Affiliation(s)
- R R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - P Daru
- University Research Co., Washington DC
| | - A E Barrera
- Faculty of Nursing Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S M Mostofa Kamal
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - S Islam
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - M Ul-Alam
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - R Sultana
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - M Rahman
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - Md S Hossain
- National Institute of Diseases of the Chest Hospital, Dhaka, Bangladesh
| | - P Lederer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - S Hurwitz
- Division of Biostatistics, Brigham and Women's Hospital Center for Clinical Investigation, Boston, Massachusetts
| | | | - N Kak
- University Research Co., Washington DC
| | - D B Tierney
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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13
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Kheang ST, Sovannaroth S, Ek S, Chy S, Chhun P, Mao S, Nguon S, Lek DS, Menard D, Kak N. Correction to: Prevalence of K13 mutation and Day-3 positive parasitaemia in artemisinin-resistant malaria endemic area of Cambodia: a cross-sectional study. Malar J 2017; 16:435. [PMID: 29078767 PMCID: PMC5660448 DOI: 10.1186/s12936-017-2073-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 12/04/2022] Open
Affiliation(s)
- Soy Ty Kheang
- PMI/USAID-Cambodia Malaria Elimination Project (CMEP), University Research Co. LLC, Phnom Penh, Cambodia.
| | - Siv Sovannaroth
- National Center for Parasitology, Entomology and Malaria Control, Phnow Penh, Cambodia
| | - Sovann Ek
- PMI/USAID-Cambodia Malaria Elimination Project (CMEP), University Research Co. LLC, Phnom Penh, Cambodia
| | - Say Chy
- PMI/USAID-Cambodia Malaria Elimination Project (CMEP), University Research Co. LLC, Phnom Penh, Cambodia
| | - Phally Chhun
- PMI/USAID-Cambodia Malaria Elimination Project (CMEP), University Research Co. LLC, Phnom Penh, Cambodia
| | - Sokkieng Mao
- PMI/USAID-Cambodia Malaria Elimination Project (CMEP), University Research Co. LLC, Phnom Penh, Cambodia
| | - Sokomar Nguon
- PMI/USAID-Cambodia Malaria Elimination Project (CMEP), University Research Co. LLC, Phnom Penh, Cambodia
| | - Dy Soley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnow Penh, Cambodia
| | - Didier Menard
- Pasteur Institute in Cambodia (IPC), Phnow Penh, Cambodia
| | - Neeraj Kak
- PMI/USAID-Cambodia Malaria Elimination Project (CMEP), University Research Co. LLC, Phnom Penh, Cambodia
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14
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Kheang ST, Sovannaroth S, Ek S, Chy S, Chhun P, Mao S, Nguon S, Lek DS, Menard D, Kak N. Prevalence of K13 mutation and Day-3 positive parasitaemia in artemisinin-resistant malaria endemic area of Cambodia: a cross-sectional study. Malar J 2017; 16:372. [PMID: 28903755 PMCID: PMC5598042 DOI: 10.1186/s12936-017-2024-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 09/07/2017] [Indexed: 11/29/2022] Open
Abstract
Background The presence of artemisinin-resistant malaria parasites was confirmed in western Cambodia in 2009. In 2013, mutations in the propeller domain of the kelch protein K13 was found to be associated with artemisinin resistance. A cross-sectional study was conducted to determine the prevalence of Day-3 parasitaemia, estimate the frequency of k13 molecular marker and assess their relationship in the context of operational research. Methods Blood smears and filter paper blood spots were collected from febrile patients in Kravanh District, Pursat Province. The blood smears were examined by microscopy, and blood spots by a k13 mutation assay. Results Data from 92 patients were analysed. Only one was positive for Day-3 parasitaemia. Results of the k13 assay were interpretable for 76 of the 92 samples. The findings were: wild type: 9 (12%), C580Y: 64 (84%), Y493H: 3 (4%). Therefore, despite the high prevalence of k13 mutants (67/76: 88%), only 1 of the 92 patients remained blood smear positive for Plasmodium falciparum on Day-3. Conclusions These preliminary findings suggest good potency of artemisinin despite the dominance of k13 mutation in Kravanh, but the result is not necessarily representative of the western part of Cambodia. Further investigation should be made to determine if k13 marker remains useful as a tool for tracking artemisinin resistance and predicting the trend of the efficacy of artemisinin combination therapy once the mutant alleles have been well established in the population.
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Affiliation(s)
- Soy Ty Kheang
- PMI/USAID Control and Prevention of Malaria (CAP-Malaria)/Cambodia Malaria Elimination Project (CMEP) projects, University Research Co., LLC, Phnow Penh, Cambodia.
| | - Siv Sovannaroth
- National Center for Parasitology, Entomology and Malaria Control, Phnow Penh, Cambodia
| | - Sovann Ek
- PMI/USAID Control and Prevention of Malaria (CAP-Malaria)/Cambodia Malaria Elimination Project (CMEP) projects, University Research Co., LLC, Phnow Penh, Cambodia
| | - Say Chy
- PMI/USAID Control and Prevention of Malaria (CAP-Malaria)/Cambodia Malaria Elimination Project (CMEP) projects, University Research Co., LLC, Phnow Penh, Cambodia
| | - Phally Chhun
- PMI/USAID Control and Prevention of Malaria (CAP-Malaria)/Cambodia Malaria Elimination Project (CMEP) projects, University Research Co., LLC, Phnow Penh, Cambodia
| | - Sokkieng Mao
- PMI/USAID Control and Prevention of Malaria (CAP-Malaria)/Cambodia Malaria Elimination Project (CMEP) projects, University Research Co., LLC, Phnow Penh, Cambodia
| | - Sokomar Nguon
- PMI/USAID Control and Prevention of Malaria (CAP-Malaria)/Cambodia Malaria Elimination Project (CMEP) projects, University Research Co., LLC, Phnow Penh, Cambodia
| | - Dy Soley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnow Penh, Cambodia
| | - Didier Menard
- Pasteur Institute in Cambodia (IPC), Phnow Penh, Cambodia
| | - Neeraj Kak
- PMI/USAID Control and Prevention of Malaria (CAP-Malaria)/Cambodia Malaria Elimination Project (CMEP) projects, University Research Co., LLC, Phnow Penh, Cambodia
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15
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Al-Hemiery N, Dabbagh R, Hashim MT, Al-Hasnawi S, Abutiheen A, Abdulghani EA, Al-Diwan JK, Kak N, Al Mossawi H, Maxwell JC, Brecht ML, Antonini V, Hasson A, Rawson RA. Self-reported substance use in Iraq: findings from the Iraqi National Household Survey of Alcohol and Drug Use, 2014. Addiction 2017; 112:1470-1479. [PMID: 28238214 DOI: 10.1111/add.13800] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/15/2016] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the prevalence of tobacco, alcohol and drug use in Iraq using data from the Iraqi National Household Survey of Alcohol and Drug Use (INHSAD). DESIGN A cross-sectional survey was conducted using a multi-stage cluster sampling method. Trained surveyors conducted face-to-face household interviews. SETTING Iraq, from April 2014 to December 2014. PARTICIPANTS A total of 3200 adult, non-institutionalized Iraqi citizens residing across all 18 governorates of Iraq. MEASUREMENTS We estimated weighted prevalence and 95% confidence intervals (CIs) for life-time, past-year and past-month use of a variety of substances (tobacco, alcohol, prescription drugs and illicit drugs). For each substance, we also estimated whether individuals knew people who currently use the substance. FINDINGS Self-reported past-month tobacco use was 23.2% (95% CI = 21.40, 25.19). Past-month alcohol use was 3.2% (95% CI = 2.58, 3.93). Women reported significantly lower prevalence for both tobacco and alcohol use compared with men (P-value < 0.01 for both). Only 1.4% (95% CI = 0.67, 3.02) reported past-month non-medical use of any prescription drugs. None of the women reported using any illicit drugs, and only 0.2% (95% CI = 0.07, 0.49) of men reported using any illicit drugs in the past month. Approximately 90.5% (95% CI = 88.58, 92.11) knew someone who uses tobacco, 42.4% (95% CI = 39.53, 45.24) knew someone who drinks alcohol, 27.9% (95% CI = 25.53, 30.45) knew someone who uses medication outside a doctor's instructions and 9.2% (95% CI = 7.87, 10.75) knew someone who uses an illicit drug. CONCLUSIONS Psychoactive drug use is generally low in Iraq, tobacco being highest at an estimated 23.2%. Iraqi women report significantly less substance use than Iraqi men, which may be related to cultural gender norms. Discrepancy between self-report and 'knowing someone who uses a substance' suggests under-reporting in this population.
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Affiliation(s)
- Nesif Al-Hemiery
- Psychiatry Division, Department of Medicine, College of Medicine, University of Baghdad, Iraq
| | - Rufaidah Dabbagh
- Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Mushtaq T Hashim
- Psychiatry Division, Department of Medicine, College of Medicine, University of Baghdad, Iraq
| | | | - Ali Abutiheen
- Department of Family and Community, Medicine College of Medicine, Kerbala University, Iraq
| | | | - Jawad K Al-Diwan
- Department of Community Medicine, College of Medicine, University of Baghdad, Iraq
| | - Neeraj Kak
- University Research Co. LLC, Center for Human Services, Bethesda, ND, USA
| | - Hala Al Mossawi
- University Research Co. LLC, Center for Human Services, Bethesda, ND, USA
| | | | - Mary-Lynn Brecht
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Valerie Antonini
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Albert Hasson
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Richard A Rawson
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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16
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Leang R, Khu NH, Mukaka M, Debackere M, Tripura R, Kheang ST, Chy S, Kak N, Buchy P, Tarantola A, Menard D, Roca-Felterer A, Fairhurst RM, Kheng S, Muth S, Ngak S, Dondorp AM, White NJ, Taylor WRJ. Erratum to: An optimised age-based dosing regimen for single low-dose primaquine for blocking malaria transmission in Cambodia. BMC Med 2016; 14:213. [PMID: 27993160 PMCID: PMC5168816 DOI: 10.1186/s12916-016-0765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rithea Leang
- National Center for Parasitology, Entomology and Malaria Control, Corner St. 92, Trapeng Svay Village, Sangkat Phnom Penh, Thmei, Khan Sen Sok, Phnom Penh, Cambodia
| | - Naw Htee Khu
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand.,Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Mark Debackere
- MSF Belgium Cambodia Malaria Program, #19, Street 388, Sangkat Tuol Svay Prey, Khan Chamkarmon, PO Box 1933, Phnom Penh, Cambodia
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand
| | - Soy Ty Kheang
- University Research Co., LLC, MK Building, House #10 (2nd floor), St. 214, Chey Chumneas, Daun Penh, Phnom Penh, Cambodia
| | - Say Chy
- University Research Co., LLC, MK Building, House #10 (2nd floor), St. 214, Chey Chumneas, Daun Penh, Phnom Penh, Cambodia
| | - Neeraj Kak
- University Research Co., LLC Washington DC: 7200 Wisconsin Ave, Bethesda, MD, 20814, USA
| | - Philippe Buchy
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, PO Box 983, Phnom Penh, 12201, Cambodia
| | - Arnaud Tarantola
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, PO Box 983, Phnom Penh, 12201, Cambodia
| | - Didier Menard
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, PO Box 983, Phnom Penh, 12201, Cambodia
| | - Arantxa Roca-Felterer
- Malaria Consortium, House #91 Street 95, Boeung Trabek, Chamkar Morn, Phnom Penh, Cambodia
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20852, USA
| | - Sim Kheng
- National Center for Parasitology, Entomology and Malaria Control, Corner St. 92, Trapeng Svay Village, Sangkat Phnom Penh, Thmei, Khan Sen Sok, Phnom Penh, Cambodia
| | - Sinoun Muth
- National Center for Parasitology, Entomology and Malaria Control, Corner St. 92, Trapeng Svay Village, Sangkat Phnom Penh, Thmei, Khan Sen Sok, Phnom Penh, Cambodia
| | - Song Ngak
- FHI 360 Cambodia Office, #03, Street 330 Boeung Keng Kang III Khan Chamkamon, PO Box: 2586, Phnom Penh, Cambodia
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand.,Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand.,Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Walter Robert John Taylor
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand. .,Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK. .,Centre de Médecine Humanitaire, Hôpitaux Universitaires de Genève, Genève, Switzerland.
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17
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Leang R, Khu NH, Mukaka M, Debackere M, Tripura R, Kheang ST, Chy S, Kak N, Buchy P, Tarantola A, Menard D, Roca-Felterer A, Fairhurst RM, Kheng S, Muth S, Ngak S, Dondorp AM, White NJ, Taylor WRJ. An optimised age-based dosing regimen for single low-dose primaquine for blocking malaria transmission in Cambodia. BMC Med 2016; 14:171. [PMID: 27784313 PMCID: PMC5081959 DOI: 10.1186/s12916-016-0701-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 09/20/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In 2012, the World Health Organization recommended the addition of single low-dose primaquine (SLDPQ, 0.25 mg base/kg body weight) to artemisinin combination therapies to block the transmission of Plasmodium falciparum without testing for glucose-6-phosphate dehydrogenase deficiency. The targeted group was non-pregnant patients aged ≥ 1 year (later changed to ≥ 6 months) with acute uncomplicated falciparum malaria, primarily in countries with artemisinin-resistant P. falciparum (ARPf). No dosing regimen was suggested, leaving malaria control programmes and clinicians in limbo. Therefore, we designed a user-friendly, age-based SLDPQ regimen for Cambodia, the country most affected by ARPf. METHODS By reviewing primaquine's pharmacology, we defined a therapeutic dose range of 0.15-0.38 mg base/kg (9-22.5 mg in a 60-kg adult) for a therapeutic index of 2.5. Primaquine doses (1-20 mg) were tested using a modelled, anthropometric database of 28,138 Cambodian individuals (22,772 healthy, 4119 with malaria and 1247 with other infections); age distributions were: 0.5-4 years (20.0 %, n = 5640), 5-12 years (9.1 %, n = 2559), 13-17 years (9.1 %, n = 2550), and ≥ 18 years (61.8 %, n = 17,389). Optimal age-dosing groups were selected according to calculated mg base/kg doses and proportions of individuals receiving a therapeutic dose. RESULTS Four age-dosing bands were defined: (1) 0.5-4 years, (2) 5-9 years, (3) 10-14 years, and (4) ≥15 years to receive 2.5, 5, 7.5, and 15 mg of primaquine base, resulting in therapeutic doses in 97.4 % (5494/5640), 90.5 % (1511/1669), 97.7 % (1473/1508), and 95.7 % (18,489/19,321) of individuals, respectively. Corresponding median (1st-99th centiles) mg base/kg doses of primaquine were (1) 0.23 (0.15-0.38), (2) 0.29 (0.18-0.45), (3) 0.27 (0.15-0.39), and (4) 0.29 (0.20-0.42). CONCLUSIONS This age-based SLDPQ regimen could contribute substantially to malaria elimination and requires urgent evaluation in Cambodia and other countries with similar anthropometric characteristics. It guides primaquine manufacturers on suitable tablet strengths and doses for paediatric-friendly formulations. Development of similar age-based dosing recommendations for Africa is needed.
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Affiliation(s)
- Rithea Leang
- National Center for Parasitology, Entomology and Malaria Control, Corner St. 92, Trapeng Svay Village, Sangkat Phnom Penh, Thmei, Khan Sen Sok, Phnom Penh, Cambodia
| | - Naw Htee Khu
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand.,Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Mark Debackere
- MSF Belgium Cambodia Malaria Program, #19, Street 388, Sangkat Tuol Svay Prey, Khan Chamkarmon, PO Box 1933, Phnom Penh, Cambodia
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand
| | - Soy Ty Kheang
- University Research Co., LLC, MK Building, House #10 (2nd floor), St. 214, Chey Chumneas, Daun Penh, Phnom Penh, Cambodia
| | - Say Chy
- University Research Co., LLC, MK Building, House #10 (2nd floor), St. 214, Chey Chumneas, Daun Penh, Phnom Penh, Cambodia
| | - Neeraj Kak
- University Research Co., LLC Washington DC: 7200 Wisconsin Ave, Bethesda, MD, 20814, USA
| | - Philippe Buchy
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, PO Box 983, Phnom Penh, 12201, Cambodia
| | - Arnaud Tarantola
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, PO Box 983, Phnom Penh, 12201, Cambodia
| | - Didier Menard
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, PO Box 983, Phnom Penh, 12201, Cambodia
| | - Arantxa Roca-Felterer
- Malaria Consortium, House #91 Street 95, Boeung Trabek, Chamkar Morn, Phnom Penh, Cambodia
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20852, USA
| | - Sim Kheng
- National Center for Parasitology, Entomology and Malaria Control, Corner St. 92, Trapeng Svay Village, Sangkat Phnom Penh, Thmei, Khan Sen Sok, Phnom Penh, Cambodia
| | - Sinoun Muth
- National Center for Parasitology, Entomology and Malaria Control, Corner St. 92, Trapeng Svay Village, Sangkat Phnom Penh, Thmei, Khan Sen Sok, Phnom Penh, Cambodia
| | - Song Ngak
- FHI 360 Cambodia Office, #03, Street 330 Boeung Keng Kang III Khan Chamkamon, PO Box: 2586, Phnom Penh, Cambodia
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand.,Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand.,Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Walter Robert John Taylor
- Mahidol Oxford Tropical Medicine Research Unit (MORU), 420/6 Rajvithi Road, Rajthevee, Bangkok, 10400, Thailand. .,Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK. .,Centre de Médecine Humanitaire, Hôpitaux Universitaires de Genève, Genève, Switzerland.
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Jensen ER, Kak N, Satjawinata K, Wirawan DN, Nangoy N. Contraceptive pricing and prevalence: family planning self-sufficiency in Indonesia. Int J Health Plann Manage 1994; 9:349-59. [PMID: 10139513 DOI: 10.1002/hpm.4740090407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Imposing or increasing user fees can move family planning programs toward self-sufficiency. But, economic theory predicts that quantities demanded decrease following price increases; and, that the size of the response depends, all else constant, upon the share of income accounted for by spending on the good or service. This article uses survey data collected in conjunction with an Indonesian self-sufficiency program to assess the differential magnitudes of contraceptive usage responses to price differentials between sample-wide and relatively poor households, and for both subsidized and full private-sector prices. We find a much more substantial response among poor households. As prices move up toward full cost-recovery, the effect is magnified.
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Affiliation(s)
- E R Jensen
- Economics Department, College of William and Mary, Williamsburg, VA 23187
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Abstract
SummaryHigh levels of fertility in rural areas of many developing societies are an issue of considerable concern to the scientific community and to those interested in public policy. This paper reports on the determinants of fertility in two rural areas in Egypt: Menoufia and Beni-Suef governorates. There are important differences in fertility between the two areas; the total fertility rate is 7·88 in Beni-Suef and 6·03 in Menoufia. These aggregate differences are the result of even larger differences between the two areas in the proximate determinants of fertility, particularly age at marriage, breast-feeding and contraceptive use. Much of the difference in breast-feeding behaviour can be explained by differences in the educational composition of the two populations; the level of female education in Menoufia is considerably higher than in Beni-Suef. However, differences in contraceptive use cannot be explained by differences in the socioeconomic composition of the two populations. The differences may be the result of greater institutional support for contraceptive use and lower fertility in Menoufia, where intensive family planning and maternal health programmes have been in operation for several years.
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Gallen ME, Liskin L, Kak N. Men--new focus for family planning programs. Popul Rep J 1986:J889-919. [PMID: 3582720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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