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Ali MH, Kitau J, Ali AS, Al-Mafazy AW, Tegegne SG, Ussi O, Musanhu C, Shija SJ, Khatib BO, Mkali H, Mkude S, Makenga G, Kasagama E, Molteni F, Kisoka N, Kitojo C, Serbantez N, Reaves E, Yoti Z. Malaria elimination in Zanzibar: where next? Pan Afr Med J 2023; 45:7. [PMID: 37538363 PMCID: PMC10395111 DOI: 10.11604/pamj.supp.2023.45.1.39804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/12/2023] [Indexed: 08/05/2023] Open
Abstract
In 2018, Zanzibar developed a national malaria strategic plan IV (2018-2023) to guide elimination of malaria by 2023. We assessed progress in the implementation of malaria activities as part of the end-term review of the strategic plan. The review was done between August and October 2022 following the WHO guideline to assess progress made towards malaria elimination, effectiveness of the health systems in delivering malaria case management; and malaria financing. A desk review examined available malaria data, annual work plans and implementation reports for evidence of implemented malaria activities. This was complemented by field visits to selected health facilities and communities by external experts, and interviews with health management teams and inhabitants to authenticate desk review findings. A steady increase in the annual parasite incidence (API) was observed in Zanzibar, from 2.7 (2017) to 3.6 (2021) cases per 1,000 population with marked heterogeneity between areas. However, about 68% of the detected malaria cases were imported into Zanzibar. Malaria case follow-up and investigation increased from <70% in 2017 to 94% and 96% respectively, in 2021. The review noted a 3.7-fold increase of the health allocation in the country's budget, from 31.7 million USD (2017/18) to 117.3 million USD (2022/23) but malaria allocation remained low (<1%). The varying transmission levels in the islands suggest a need for strategic re-orientation of the elimination attempts from a national-wide to a sub-national agenda. We recommend increasing malaria allocation from the health budget to ensure sustainability of malaria elimination interventions.
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Affiliation(s)
- Mohamed Haji Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Jovin Kitau
- World Health Organization, Country office, Dar-es-Salaam, Tanzania
| | | | - Abdul-wahid Al-Mafazy
- Second Vice President Office-Zanzibar Country Coordinating Mechanism, Zanzibar, Tanzania
| | | | - Omar Ussi
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | | | - Shija Joseph Shija
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Bakari Omar Khatib
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Humphrey Mkali
- Population Services International, Dar-es-Salaam, Tanzania
| | - Sigsbert Mkude
- Population Services International, Dar-es-Salaam, Tanzania
| | | | | | - Fabrizio Molteni
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Noela Kisoka
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Chonge Kitojo
- US President´s Malaria Initiative, United States Agency for International Development, Dar-es-Salaam, United Republic of Tanzania
| | - Naomi Serbantez
- US President´s Malaria Initiative, United States Agency for International Development, Dar-es-Salaam, United Republic of Tanzania
| | - Erik Reaves
- United States Centers for Disease Control, Dar-es-Salaam, Tanzania
| | - Zabulon Yoti
- World Health Organization, Country office, Dar-es-Salaam, Tanzania
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Redae GA, Mengestu TK, Abdalla FM, Slim SN, Simon VT, Ali AO, Saguti GE, Habtu MM, Tegegne SG, Msambazi MJ, Zabulon Y. Towards cholera elimination in Zanzibar: analysis of evidences on what have worked. Pan Afr Med J 2023; 45:6. [PMID: 37538360 PMCID: PMC10395108 DOI: 10.11604/pamj.supp.2023.45.1.39828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/12/2023] [Indexed: 08/05/2023] Open
Abstract
Cholera, an enteric disease caused by Vibrio cholera claims thousands of lives yearly. The disease is a disease of inequality that affect populations which have poor access to safe water and sanitation facilities. Zanzibar, an archipelago in the Indian ocean which is part of the United Republic of Tanzania has been affected by recurrent cholera outbreak for the past decades. A multi-sectoral and multi-year three pillar approach namely Enabling Environment, Prevention and Response, for the elimination of cholera were initiated by the stewardship of the government, engagement of the community and technical and financial support of partners. The approach has enabled Zanzibar to interrupt the recurrent cholera outbreak for the past five years. The analysis of evidences have proven that creating an enabling environment through multi-sectoral involvement, mobilizing communities, intensifying surveillance complemented by the traditional disease prevention and control interventions has resulted to interruption of cholera transmission in the country.
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Affiliation(s)
| | | | | | | | | | - Ali Omar Ali
- World Health Organization Country Office, Dar es Salaam, Tanzania
| | | | | | | | | | - Yoti Zabulon
- World Health Organization Country Office, Dar es Salaam, Tanzania
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Tegegne SG, Mengestu TK, Francisco K, Bollars C, Kapanga H, Galbert FT, Andemichael G, Musanhu C, Maxmillan M, Neema K, Saguti G, Phyllis J, Nsubuga P, Zablon Y. Process of developing Country Cooperation Strategy in Tanzania, as an effective tool for aligning WHO's support to the member state in achieving health and health-related sustainable development goal. Pan Afr Med J 2023; 45:2. [PMID: 37538367 PMCID: PMC10395106 DOI: 10.11604/pamj.supp.2023.45.1.39584] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/10/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction an organization's long-term success and relevance are linked with compelling strategic development. To that end, the country office of WHO in the United Republic of Tanzania, in collaboration with stakeholders, developed a 6-year Country Cooperation Strategy (CCS), 2022-2027. This paper describes the various steps taken in developing the CCS for the United Republic of Tanzania. Methods we reviewed the global guideline for the development of CCS. In addition, we analysed documents on the national health sector strategic plan, the 13th Global Program of Work for WHO (GPW13), and the Sustainable Development Goal (SDG). We also reviewed data from routine HMIS, the Global Burden of Disease (GBD), and assessment results of the UN on the status of SDGs through the Common Country Assessment (CCA). Results the performance on the overall Universal Health Coverage (UHC) effective coverage index, on a scale of 0-100, for Tanzania improved from 45.2 in 2010 to 55.2 in 2019. Strengthening health systems, protecting communities against public health emergencies, reducing or controlling exposure of individuals to risk factors, and better health governance, leadership, and accountability were the identified priorities for the CCS. Conclusion the process of alignment of the CCS document with the national and global strategic goals would help the WHO to support and lead the country's effort towards achieving health-related SDGs. We believe the process we employed will lead to having detailed operational plans for implementation for achieving SDG targets. Keywords Country cooperation strategy (CCS), sustainable development goal (SDG), strategic document, 13th global program of work (GPW13), health sector strategy, stakeholders, Tanzania.
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Affiliation(s)
| | | | | | - Caroline Bollars
- World Health Organization European Regional Office, Copenhagen, Denmark
| | | | | | | | | | | | - Kileo Neema
- World Health Organization Country Office, Dar es Salaam, Tanzania
| | - Grace Saguti
- World Health Organization Country Office, Dar es Salaam, Tanzania
| | - Jiri Phyllis
- World Health Organization European Regional Office, Copenhagen, Denmark
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, USA
| | - Yoti Zablon
- World Health Organization Country Office, Dar es Salaam, Tanzania
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Ibrahim LM, Okudo I, Stephen M, Ogundiran O, Pantuvo JS, Oyaole DR, Tegegne SG, Khalid A, Ilori E, Ojo O, Ihekweazu C, Baraka F, Mulombo WK, Lasuba CLP, Nsubuga P, Alemu W. Electronic reporting of integrated disease surveillance and response: lessons learned from northeast, Nigeria, 2019. BMC Public Health 2021; 21:916. [PMID: 33985451 PMCID: PMC8117577 DOI: 10.1186/s12889-021-10957-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/04/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Electronic reporting of integrated disease surveillance and response (eIDSR) was implemented in Adamawa and Yobe states, Northeastern Nigeria, as an innovative strategy to improve disease reporting. Its objectives were to improve the timeliness and completeness of IDSR reporting by health facilities, prompt identification of public health events, timely information sharing, and public health action. We evaluated the project to determine whether it met its set objectives. METHOD We conducted a cross-sectional study to assess and document the lessons learned from the project. We reviewed the performance of the local government areas (LGAs) on timeliness and completeness of reporting, rumors identification, and reporting on the eIDSR and the traditional paper-based system using a checklist. Respondents were interviewed online on the relevance, efficiency, sustainability, project progress and effectiveness, the effectiveness of management, and potential impact and scalability of the strategy using structured questionnaires. Data were cleaned, analyzed, and presented as proportions using an MS Excel spreadsheet. Responses were also presented as direct quotes. RESULTS The number of health facilities reporting IDSR increased from 103 to 228 (117%) before and after implementation of the eIDSR respectively. The timeliness of reporting was 43% in the LGA compared to 73% in health facilities implementing eIDSR. The completeness of IDSR reports in the last 6 months before the evaluation was ≥85%. Of the 201 rumors identified and verified, 161 (80%) were from the eIDSR pilot sites. The majority of the stakeholders interviewed believed that eIDSR met its predetermined objectives for public health surveillance. The benefits of eIDSR included timely reporting and response to alerts and disease outbreaks, improved timeliness, and completeness of reporting, and supportive supervision to the operational levels. The strategy helped stakeholders to appreciate their roles in public health surveillance. CONCLUSION The eIDSR has increased the number of health facilities reporting IDSR, enabled early identification, reporting, and verification of alerts, improved timeliness and completeness of reports, and supportive supervision of staff at the operational levels. It was well accepted by the stakeholder as a system that made reporting easy with the potential to improve the public health surveillance system in Nigeria.
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Affiliation(s)
- Luka Mangveep Ibrahim
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria.
| | - Ifeanyi Okudo
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | | | | | - Jerry Shitta Pantuvo
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | | | - Sisay Gashu Tegegne
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | - Abdelrahim Khalid
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | - Elsie Ilori
- Nigerian Center for Disease Control, Jabi, Abuja, Nigeria
| | - Olubunmi Ojo
- Nigerian Center for Disease Control, Jabi, Abuja, Nigeria
| | | | - Fiona Baraka
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
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Ticha JM, Akpan GU, Paige LM, Senouci K, Stein A, Briand P, Tuma J, Oyaole DR, Ngofa R, Maleghemi S, Touray K, Salihu AA, Diallo M, Tegegne SG, Bello IM, Idris UK, Maduka O, Manengu C, Shuaib F, Galway M, Mkanda P. Outcomes of the Deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) System for Strengthening Polio Surveillance in Africa From 2017 to 2018: Evaluation Study. JMIR Public Health Surveill 2020; 6:e18950. [PMID: 33263550 PMCID: PMC7744265 DOI: 10.2196/18950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/19/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background As we move toward a polio-free world, the challenge for the polio program is to create an unrelenting focus on smaller areas where the virus is still present, where children are being repeatedly missed, where immunity levels are low, and where surveillance is weak. Objective This article aimed to describe a possible solution to address weak surveillance systems and document the outcomes of the deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) project. Methods This intervention was implemented in 99 targeted high-risk districts with concerns for silent polio circulation from eight countries in Africa between August 1, 2017, and July 31, 2018. A total of 6954 persons (5390 community informants and 1564 health workers) were trained and equipped with a smartphone on which the AVADAR app was configured to allow community informants to send alerts on suspected acute flaccid paralysis (AFP) and allow health worker to use electronic checklists for investigation of such alerts. The AVADAR and Open Data Kit ONA servers were at the center of the entire process. A dashboard system and coordination teams for monitoring and supervision were put in place at all levels. Results Overall, 96.44% (24,142/25,032) of potential AFP case alerts were investigated by surveillance personnel, yielding 1414 true AFP cases. This number (n=1414) reported through AVADAR was higher than the 238 AFP cases expected during the study period in the AVADAR districts and the 491 true AFP cases reported by the traditional surveillance system. A total of 203 out of the 1414 true AFP cases reported were from special population settings, such as refugee camps and insecure areas. There was an improvement in reporting in silent health areas in all the countries using the AVADAR system. Finally, there were 23,473 reports for other diseases, such as measles, diarrhea, and cerebrospinal meningitis, using the AVADAR platform. Conclusions This article demonstrates the added value of AVADAR to rapidly improve surveillance sensitivity. AVADAR is capable of supporting countries to improve surveillance sensitivity within a short interval before and beyond polio-free certification.
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Affiliation(s)
| | - Godwin Ubong Akpan
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Lara Mf Paige
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Kamel Senouci
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Andrew Stein
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | | | - Jude Tuma
- World Health Organization, Geneva, Switzerland
| | | | - Reuben Ngofa
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Kebba Touray
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Mamadou Diallo
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | - Casimir Manengu
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Faisal Shuaib
- National Primary Health Care Delivery Agency (NPHCDA), Abuja, Nigeria
| | - Michael Galway
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Pascal Mkanda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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Bassey BE, Braka F, Shuaib F, Banda R, Tegegne SG, Ticha JM, Abdullalhi WH, Kolawole OM, Kabir Y. Distribution pattern of poliovirus potentially infectious materials in the phase 1b medical laboratories containment in conformity with the global action plan III. BMC Public Health 2018; 18:1319. [PMID: 30541511 PMCID: PMC6291917 DOI: 10.1186/s12889-018-6183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/30/2022] Open
Abstract
Background The containment of poliovirus infectious/potentially infectious materials in all biomedical facilities in Nigeria remain crucial to maintaining gains recorded towards polio eradication. Activities involved in the Nigerian Poliovirus type 2-laboratory containment survey in line with the 3rd Global Action Plan III (GAP III) for poliovirus containment are documented in this study. Through these activities, the overall preparedness for poliovirus eradication in Nigeria is assessed. Method A cross-sectional survey was conducted from 19th September-31st October 2016 using structured Laboratory survey and inventory (LSI) questionnaires uploaded onto the SPSS software package in 560 biomedical facilities classified either as high risk or medium risk facilities across the 6 zones in Nigeria. Results In total, 560 biomedical facilities were surveyed in Nigeria in conformity with the GAP III. In total, 86% of the facilities surveyed were with laboratories while 14% were without laboratories. Twelve laboratories with poliovirus potentially infectious materials were identified in this exercise. In total, 50% of the 12 laboratories were under the ministry of education for research purposes. While 33% were among those laboratories surveyed in the phase 1a exercise without any recorded inventory, but have acquired some since the phase 1a survey. A total of 13,484 poliovirus infectious materials were found in the 12 laboratories. Only 8% of the materials were immediately destroyed while the remaining materials (62%) were found in Oyo and Borno states scheduled for destruction within 3–4 months according to WHO protocol for destruction of poliovirus infectious materials. Conclusion This study has revealed the successful containment of all poliovirus infectious materials in the laboratories surveyed. It has also revealed some surveillance gaps. We recommend that the surveillance system be improved to maintain the gains from the containment exercise and avoid reintroduction of infectious materials into biomedical facilities. This reduces the chances of viral reintroduction to the population in general.
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Affiliation(s)
- Bassey Enya Bassey
- , World Health organization (WHO) Nigeria Country office, UN House, plot 617/618, Diplomatic Drive, Central Business District, PMB 2861, Garki, Abuja, Nigeria.
| | - Fiona Braka
- , World Health organization (WHO) Nigeria Country office, UN House, plot 617/618, Diplomatic Drive, Central Business District, PMB 2861, Garki, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health care Development Agency, Abuja, Nigeria
| | - Richard Banda
- , World Health organization (WHO) Nigeria Country office, UN House, plot 617/618, Diplomatic Drive, Central Business District, PMB 2861, Garki, Abuja, Nigeria
| | - Sisay Gashu Tegegne
- , World Health organization (WHO) Nigeria Country office, UN House, plot 617/618, Diplomatic Drive, Central Business District, PMB 2861, Garki, Abuja, Nigeria
| | - Johnson Muluh Ticha
- , World Health organization (WHO) Nigeria Country office, UN House, plot 617/618, Diplomatic Drive, Central Business District, PMB 2861, Garki, Abuja, Nigeria
| | - Walla Hamisu Abdullalhi
- , World Health organization (WHO) Nigeria Country office, UN House, plot 617/618, Diplomatic Drive, Central Business District, PMB 2861, Garki, Abuja, Nigeria
| | - Olatunji Mathew Kolawole
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Yusuf Kabir
- National Primary Health care Development Agency, Abuja, Nigeria
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Bassey BE, Braka F, Vaz RG, Komakech W, Maleghemi ST, Koko R, Igbu T, Ireye F, Agwai S, Akpan GU, Tegegne SG, Mohammed AAG, Okocha-Ejeko A. The global switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV): facts, experiences and lessons learned from the south-south zone; Nigeria, April 2016. BMC Infect Dis 2018; 18:57. [PMID: 29374467 PMCID: PMC5787308 DOI: 10.1186/s12879-018-2963-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background The globally synchronized switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) took place in Nigeria on April 18th 2016. The country is divided into six geopolitical zones. This study reports the experiences and lessons learned from the switch process in the six states that make up Nigeria’s south-south geopolitical zone. Methods This was a descriptive retrospective review of Nigeria’s switch plan and structures used for implementing the tOPV-bOPV switch in the south-south zone. Nigeria’s National Polio Emergency Operation Centre (NPEOC) protocols, global guidelines and reports from switch supervisors during the switch were used to provide background information for this study. Quantitative data were derived from reviewing switch monitoring and validation documents as submitted to the NPEOC Results The switch process took place in all 3078 Health Facilities (HFs) and 123 Local Government Areas (LGAs) that make up the six states in the zone. A total of $139,430 was used for this process. The ‘healthcare personnel’ component received the highest budgetary allocation (59%) followed by the ‘logistics’ component (18%). Akwa Ibom state was allocated the highest number of healthcare personnel and hence received the most budgetary allocation compared to the six states (total healthcare personnel = 458, total budgetary allocation = $17,428). Validation of the switch process revealed that eight HFs in Bayelsa, Cross-River, Edo and Rivers states still possessed tOPV in cold-chain while six HFs in Cross-River and Rivers states had tOPV out of cold-chain but without the ‘do not use’ sticker. Akwa-Ibom was the only state in the zone to have bOPV and Inactivated Polio Vaccine (IPV) available in all its HFs monitored. Conclusion The Nigerian tOPV-bOPV switch was successful. For future Oral Polio Vaccine (OPV) withdrawals, implementation of the switch plan would be more feasible with an earlier dissemination of funds from global donor organizations, which would greatly aid timely planning and preparations. Increased budgetary allocation to the ‘logistics’ component to accommodate unexpected hikes in transportation prices and the general inefficiencies with power supply in the country is also advised.
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