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Rozelle JW, Korvah J, Wiah O, Kraemer J, Hirschhorn LR, Price MR, Subah M, McCormick L, Varpilah B, Panjabi R. Improvements in malaria testing and treatment after a national community health worker program in rural Liberia. Journal of Global Health Reports 2021. [DOI: 10.29392/001c.25979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | | | - John Kraemer
- Last Mile Health, Monrovia, Liberia; Georgetown University, Washington DC, United States
| | - Lisa R. Hirschhorn
- Last Mile Health, Boston, Massachusetts, United States; Northwestern University, Chicago, Illinois, United States
| | - Matt R. Price
- Last Mile Health, Boston, Massachusetts, United States
| | | | | | | | - Rajesh Panjabi
- Last Mile Health, Boston, Massachusetts, United States; Harvard Medical School, Boston, Massachusetts, United States
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Steketee RW, Choi M, Linn A, Florey L, Murphy M, Panjabi R. World Malaria Day 2021: Commemorating 15 Years of Contribution by the United States President's Malaria Initiative. Am J Trop Med Hyg 2021; 104:1955-1959. [PMID: 33891560 PMCID: PMC8176495 DOI: 10.4269/ajtmh.21-0432] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/18/2021] [Indexed: 12/04/2022] Open
Abstract
World Malaria Day 2021 coincides with the 15th anniversary of the United States President’s Malaria Initiative (PMI) and follows the first anniversary of the declaration of the coronavirus disease (COVID-19) pandemic. From 2006 to the present, the PMI has led to considerable country-managed progress in malaria prevention, care, and treatment in 24 of the highest-burden countries in sub-Saharan Africa and three countries in the Southeast Asia Greater Mekong subregion. Furthermore, it has contributed to a 29% reduction in malaria cases and a 60% reduction in the death rates in sub-Saharan Africa. In this context of progress, substantial heterogeneity persists within and between countries, such that malaria control programs can seek subnational elimination in some populations but others still experience substantial malaria disease and death. During the COVID-19 pandemic, most malaria programs have shown resilience in delivering prevention campaigns, but many experienced important disruptions in their care and treatment of malaria illness. Confronting the COVID-19 pandemic and building on the progress against malaria will require fortitude, including strengthening the quality and ensuring the safety and resiliency of the existing programs, extending services to those currently not reached, and supporting the people and partners closest to those in need.
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Affiliation(s)
- Richard W Steketee
- 1United States President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Misun Choi
- 2United States President's Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Anne Linn
- 2United States President's Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Lia Florey
- 2United States President's Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Matthew Murphy
- 1United States President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rajesh Panjabi
- 2United States President's Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
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Luckow PW, Kenny A, White E, Ballard M, Dorr L, Erlandson K, Grant B, Johnson A, Lorenzen B, Mukherjee S, Ly EJ, McDaniel A, Nowine N, Sathananthan V, Sechler GA, Kraemer JD, Siedner MJ, Panjabi R. Implementation research on community health workers' provision of maternal and child health services in rural Liberia. Bull World Health Organ 2017; 95:113-120. [PMID: 28250511 PMCID: PMC5327932 DOI: 10.2471/blt.16.175513] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. Methods The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. Findings Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. Conclusion We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.
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Affiliation(s)
- Peter W Luckow
- Geisel School of Medicine at Dartmouth College, Hanover, United States of America (USA)
| | | | | | - Madeleine Ballard
- Department of Social Policy and Intervention, University of Oxford, Oxford, England
| | | | | | | | | | | | | | | | | | - Netus Nowine
- Grand Gedeh County Health Team, Ministry of Health, Monrovia, Liberia
| | | | - Gerald A Sechler
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - John D Kraemer
- Department of Health Systems Administration, Georgetown School of Nursing and Health Studies, Washington, USA
| | - Mark J Siedner
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Rajesh Panjabi
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Kentoffio K, Kraemer JD, Griffiths T, Kenny A, Panjabi R, Sechler GA, Selinsky S, Siedner MJ. Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization. BMC Health Serv Res 2016; 16:478. [PMID: 27604708 PMCID: PMC5015243 DOI: 10.1186/s12913-016-1709-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span. Methods We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization. Results Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001). Conclusions Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1709-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine Kentoffio
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA. .,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - John D Kraemer
- Georgetown University Medical Center, 231 St. Mary's Hall, 3700 Reservoir Road NW, Washington, DC, 20057-1107, USA
| | | | - Avi Kenny
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA
| | - Rajesh Panjabi
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - G Andrew Sechler
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | | | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
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Perry HB, Dhillon RS, Liu A, Chitnis K, Panjabi R, Palazuelos D, Koffi AK, Kandeh JN, Camara M, Camara R, Nyenswah T. Community health worker programmes after the 2013-2016 Ebola outbreak. Bull World Health Organ 2016; 94:551-3. [PMID: 27429495 PMCID: PMC4933142 DOI: 10.2471/blt.15.164020] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America (USA)
| | - Ranu S Dhillon
- Division of Global Health Equity, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Anne Liu
- Earth Institute, Columbia University, New York, USA
| | - Ketan Chitnis
- Communication for Development Section, United Nations Children's Fund, New York, USA
| | | | | | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America (USA)
| | - Joseph N Kandeh
- Directorate of Primary Health Care, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mamady Camara
- Earth Institute, Columbia University, Conakry, Guinea
| | - Robert Camara
- Directorate of Prevention and Community Health, Ministry of Health and Hygiene, Conakry, Guinea
| | - Tolbert Nyenswah
- Liberia Incident Management System for Ebola Response, Ministry of Health and Social Welfare, Monrovia, Liberia
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Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. PLoS Med 2012; 9:e1001244. [PMID: 22723748 PMCID: PMC3378609 DOI: 10.1371/journal.pmed.1001244] [Citation(s) in RCA: 354] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 05/08/2012] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. METHODS AND FINDINGS Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive dynamics" for funding appeared between the two sectors, such that public funds and personnel were redirected to private sector development, followed by reductions in public sector service budgets and staff. CONCLUSIONS Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector; however, the public sector appears frequently to lack timeliness and hospitality towards patients.
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Affiliation(s)
- Sanjay Basu
- Department of Medicine, University of California, San Francisco, California, United States of America.
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Finch TH, Chae SR, Shafaee MN, Siegel KR, Ali MK, Tomei R, Panjabi R, Kishore SP. Role of students in global health delivery. ACTA ACUST UNITED AC 2011; 78:373-81. [PMID: 21598264 DOI: 10.1002/msj.20254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
What role do students have in global health activities? On one hand, students have much to offer, including innovative ideas, fresh knowledge and perspective, and inspiring energy. At the same time, students lack technical credentials and may drain resources from host communities. Here, we examine the dynamic, contemporary roles of students in global health activities, including health delivery. We focus on 3 themes that guide engagement: (1) fostering an enabling policy environment (eg, toward greater health equity); (2) understanding and working within the local context and governments' needs; and (3) leading bidirectional partnerships. We next study the implications of short-term exposure and long-term engagement programs. We conclude with 4 recommendations on how to better equip students to engage in the next frontier of global health education and future action.
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Khan AM, Janneck LM, Bhatt J, Panjabi R, Marjoua Y, Bharwani A. Building a health-peace movement: academic medicine's role in generating solutions to global problems. Acad Med 2009; 84:1486. [PMID: 19858797 DOI: 10.1097/acm.0b013e3181bab2bf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Ali M Khan
- Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA.
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Johnson K, Asher J, Rosborough S, Raja A, Panjabi R, Beadling C, Lawry L. Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia. JAMA 2008; 300:676-90. [PMID: 18698066 DOI: 10.1001/jama.300.6.676] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Liberia's wars since 1989 have cost tens of thousands of lives and left many people mentally and physically traumatized. OBJECTIVES To assess the prevalence and impact of war-related psychosocial trauma, including information on participation in the Liberian civil wars, exposure to sexual violence, social functioning, and mental health. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, population-based, multistage random cluster survey of 1666 adults aged 18 years or older using structured interviews and questionnaires, conducted during a 3-week period in May 2008 in Liberia. MAIN OUTCOME MEASURES Symptoms of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), social functioning, exposure to sexual violence, and health and mental health needs among Liberian adults who witnessed or participated in the conflicts during the last 2 decades. RESULTS In the Liberian adult household-based population, 40% (95% confidence interval [CI], 36%-45%; n = 672/1659) met symptom criteria for MDD, 44% (95% CI, 38%-49%; n = 718/1661) met symptom criteria for PTSD, and 8% (95% CI, 5%-10%; n = 133/1666) met criteria for social dysfunction. Thirty-three percent of respondents (549/1666) reported having served time with fighting forces, and 33.2% of former combatant respondents (182/549) were female. Former combatants experienced higher rates of exposure to sexual violence than noncombatants: among females, 42.3% (95% CI, 35.4%-49.1%) vs 9.2% (95% CI, 6.7%-11.7%), respectively; among males, 32.6% (95% CI, 27.6%-37.6%) vs 7.4% (95% CI, 4.5%-10.4%). The rates of symptoms of PTSD, MDD, and suicidal ideation were higher among former combatants than noncombatants and among those who experienced sexual violence vs those who did not. The prevalence of PTSD symptoms among female former combatants who experienced sexual violence (74%; 95% CI, 63%-84%) was higher than among those who did not experience sexual violence (44%; 95% CI, 33%-53%). The prevalence of PTSD symptoms among male former combatants who experienced sexual violence was higher (81%; 95% CI, 74%-87%) than among male former combatants who did not experience sexual violence (46%; 95% CI, 39%-52%). Male former combatants who experienced sexual violence also reported higher rates of symptoms of depression and suicidal ideation. Both former combatants and noncombatants experienced inadequate access to health care (33.0% [95% CI, 22.6%-43.4%] and 30.1% [95% CI, 18.7%-41.6%], respectively). CONCLUSIONS Former combatants in Liberia were not exclusively male. Both female and male former combatants who experienced sexual violence had worse mental health outcomes than noncombatants and other former combatants who did not experience exposure to sexual violence.
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Affiliation(s)
- Kirsten Johnson
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
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Panjabi R, Comstock GW, Golub JE. Recurrent tuberculosis and its risk factors: adequately treated patients are still at high risk. Int J Tuberc Lung Dis 2007; 11:828-37. [PMID: 17705947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Recurrent tuberculosis (TB) poses significant threats, including drug resistance, to TB control programs. However, recurrence and its causes, particularly in the era of epidemic human immunodeficiency virus (HIV), have not been well described. We systematically searched published material for studies reporting on recurrent TB following completion of standard treatment regimens to provide data on the issue. A total of 32 studies were reviewed. Among controlled trials, the overall recurrence rates (per 100,000 person-years) were respectively 3,010 (95%CI 2,230-3,970) and 2,290 (95%CI 1,730-2,940) at 6 and 12 months after treatment completion. Recurrence rates were higher among observational studies compared to controlled trials and in countries with high versus low background TB incidence. TB recurrence (%) was higher among HIV-infected (6.7, 95%CI 5.9-7.6) than non-HIV-infected individuals (3.3, 95%CI 2.8-3.9). Factors independently associated with recurrence in the literature included residual cavitation, greater area of involved lung tissue, positive sputum culture at 2 months of treatment and HIV infection. Among those with HIV infection, recurrent TB was associated with a low initial CD(4) count and receiving less than 37 weeks of anti-tuberculosis treatment. We argue that adequately treated patients are still at high risk for recurrent disease and should be considered in case-finding strategies. Moreover, those with multiple risk factors may benefit from modification of standard treatment.
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Affiliation(s)
- R Panjabi
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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