Tropical Health Matters

Colleagues at the University of Ibadan have started on an important publishing endeavor as described below. Indigenous communication is an often neglected aspect of behavior change communication, and we hope this new Journal will bring more attention on how we can communicate about important health issues like malaria in ways that make sense to the community. Of course we also need to be willing to learn from the community first about their perceptions in order to have effective two-way communication:

Call for Papers for the Maiden Edition

The Editorial Board of the Journal of Indigenous and Community Communication (JICC) hereby invites original research articles, (empirical and discursive/expository), for the maiden edition of the journal that will be published in December 2014. JICC aims at offering space for scholars, researchers and development practitioners to contribute both qualitative and quantitative research findings in form of case studies, community-based situation analysis, reports of community-based interventions, evidence-based policy suggestions and intervention measures, and policy briefs. This volume will explore the theme of Community Communication and Poverty Reduction in Africa, with particular reference to the voices from community’s grassroots.

From recent researches,[1] the number of people living in absolute poverty in Africa is still high compared to most other low-income regions. Reasons given for the soaring numbers are diverse, ranging from leadership, irrelevant policies, failing institutions, human geography, among others. There are however many success stories from different African countries, stories that hardly get to find audience at the national and international levels, stories of people who through their daily struggle contribute to their betterment of their livelihoods.

This maiden edition is dedicated to how the community grassroots’ communication mechanisms contribute towards alleviating absolute poverty for those involved. Contributions to this edition should therefore centre on the efforts of knowledge and idea transfer at the very community’s basic level. Key questions around this focus include: In what ways do individuals get to exchange ideas about their own, and community’s development? Who takes initiative in the transfer of these ideas, and what informs this initiative? How (in)effective are these modes of communication? How can these grassroots, community-based communication initiatives become more widely accepted and engaged in dealing with poverty issues in African communities? What are the implications of these modes of indigenous/community-based communications with regards to reducing poverty in Africa?

Articles that explore these and other related questions, and especially field researches that are innovative and original are welcome.

Abstract submission

The first stage is to submit an abstract of a maximum of 300 words. In the abstract, indicate the gap that exists in literature and/or the key research question. It is important to link the key question to poverty and communication. Include the area (geographical) specificity of research in the case of empirical data and methodology, and how the findings will be useful in addressing/answering your research question. Include your name, institutional affiliation and email address. Once the editors have reviewed the abstracts, authors whose abstracts are accepted will be contacted to submit full papers. The deadline for abstract submission is August 10 2014. The abstracts should be submitted to: ayo.ojebode@mail.ui.edu.ng and mbusupa@yahoo.com

Article submission

Full articles should be written using the APA 6^th style referencing. The words should be limited to 7,000 including footnotes and list of references (avoid providing bibliography). Briefings and policy briefs that provide review of specific country’s topical issues should be limited to a maximum of 3,000 words. Book reviews that are relevant to the theme of the edition should not exceed 1,000 words. Full articles for this volume are due November 15 2014.

JICC does not accept articles that are under consideration by other publishers. JICC does not compromise on matters of ethics and integrity. All academic articles will be peer-reviewed blind by three reviewers. An article is not recommended for revision unless it has at least two positive reviews. Two reviewers will review briefs and reports by organisations working in communities. JICC also strives to ensure that reviewers’ reports are turned in within six weeks. JICC conducts plagiarism checks on each article submitted to it. Any article that fails the test will be rejected and the author(s) will be barred from publishing in JICC in future.

JICC will be published availed online and in print.

Funding and Outlet

The Nigerian Community Radio Coalition supports JICC. However, we welcome support from other institutions and individuals in Africa and beyond.

JICC Editorial Board:

1. Dr. Ayobami Ojebode – University of Ibadan, Nigeria
2. Dr. Susan M. Kilonzo – Maseno University, Kenya
3. Dr. Tunde Adegbola – African Languages Technology Initiative, ALT-I, Nigeria
4. Prof. Holger Briel – Xi’an Jiaotong Liverpool University, Suzhou, China
5. Prof. Kitche Magak – Maseno University, Kenya
6. Prof. Christopher J. Odhiambo – Moi University, Kenya
7. Dr. Birgitte Jallov – Empowerhouse, Denmark
8. Ms. Jackline A. Owacgiu – Uganda/London School of Economics

[1]See for example Collier, P. Poverty reduction in Africa. Accessible at http://users.ox.ac.uk/~econpco/research/pdfs/PovertyReductionInAfrica.pdf. Collier’s book-The bottom billion: Why the poorest countries are failing and what can be done about it. New York, Oxford: Oxford University Press, explores this further.

A new article by Clementine Rossier and colleagues compares access to maternal health services in Ouagadougou, Burkina Faso and Nairobi Kenya.  In both settings a very large proportion of pregnant women registered for antenatal care (ANC).  Twice the proportion of Nairobi women (47%) attended up to four times compared to those in Ouadougou (22%).  In both settings, the likelihood of attending four ANC visits increased with educational level of the women.

Although the article does not discuss services received at ANC, we can consider the implications for malaria in pregnancy (MIP) control since ANC is a major platform for MIP service delivery. Here the demographic and health survey (DHS) and its malaria indicator survey (MIS) component are of help.  Both countries had a national survey in 2010 (their most recent).

Interestingly in 2010 Burkina Faso overall had better ANC registration (05%) than Kenya (86%). In neither country was intermittent preventive treatment in pregnancy (IPTp) coverage good. 25.7% of pregnant women in Kenya received one dose of sulfadoxine-pyrimethamine for IPTp, while 20.8% did so in Burkina Faso. IPTp2 coverage in Kenya was similar at 25.4%, but in Burkina Faso it dropped to 10.6%

The important lesson here is that even with good ANC registration, women have no guarantee of receiving life saving malaria prevention services.  If registration was lower we might suspect issues of local beliefs and other community barriers, but the situation in both countries points to health systems failures like inadequate drug supplies and health worker lapses.

The service delivery situation in both countries has changed dramatically since 2010. Kenya has refined its malaria map and is focusing IPTp on areas of stable and high transmission. Burkina Faso has received greater influx of financial support from the Global Fund and the US Agency for International Development. Hopefully the 2014 DHS/MIS studies currently in progress in both countries will paint a better picture. Of course, unless health systems issues are being addressed, funding alone will not solve the malaria service gaps.

Recent reports on the Global Burden of Disease with a focus on Millennium Development Goal #6 has stressed the improvement in malaria morbidity and mortality indicators since the Abuja Declaration of 2000. In particular, “Global malaria incidence peaked in 2003, with 232 million new cases, subsequently falling by about 29% to 165 million new cases in 2013.”

The improvements are attributed in part to the large increase in funding. The remaining challenge derives in part from the fact that four countries, India, Nigeria, Democratic Republic of the Congo and Mozambique account for nearly two-thirds of the global case load. Global progress in reducing disease has been achieved despite the fact that in these and many other countries, achievement of 2010 targets for malaria intervention coverage (80%) have lagged. In some cases national surveys have shown some declines in coverage (e.g. Nigeria).

Ghana provides a good example of the challenges. National surveys in 2006, 2008 and 2011 have shown mixed results in the use of insecticide treated nets by children below the age of 5 years.  While the proportion rose from 20% to 39% between the first two surveys, it stayed steady in 2011. A new survey in underway, but as of 2012 there were still areas of the country that needed nets, and we know that nets wear out in between distributions  and need to be replaced through routine services as seen in the photo.

The three surveys so far in Ghana paint a mixed picture as seen in the attached graph.  In six of the ten regions, net coverage for young children declined and in four it increased over the period.  This on balance led to the lack of overall improvement.

Thinking back to the reduced burden of disease overall, one can surmise that even some level of malaria intervention can impact on incidence of the disease, but the goal was no mortality for 2015, just one year from now.  If the trend seen in Ghana (which is reflective of other countries) continues, we will pass 2015 without attaining the 2010 coverage targets and still experience an unacceptable malaria disease burden.  Malaria elimination looks farther away each day.

Malaria and HIV/AIDS interact on several fronts from the biological, clinical, pharmacological to the service delivery levels.  The ongoing 20th International AIDS Conference in Melbourne, Australia (July 20-25, 2014) provides an opportunity to discuss some of these issues. Abstracts that are available as of 20th July are mentioned below and deal largely with integrated health service delivery issues. Details can be found at http://www.aids2014.org/. Also keep up to date on twitter at https://twitter.com/AIDS_conference, and on Facebook at https://www.facebook.com/InternationalAIDSConference.

1. Increasing HIV testing and counseling (HTC) uptake through integration of services at community and facility level (TUPE358 – Poster Exhibition). E. Aloyo Nyamugisa, B. Otucu, J.P. Otuba, L. Were, J. Komagum, F. Ocom, C. Musumali (USAID/NU-HITES Project, Plan International – Uganda, Gulu, Uganda).

HTC integration at community outreaches and facility service points increases service uptake by individuals, families and couples that come to access the different services that are offered concurrently such as immunization, family planning, cervical cancer screening, circumcision, Tuberculosis, malaria, nutrition screening services and other medical care.

2. Asymptomatic Malaria and HIV/AIDS co-morbidity in sickle cell disease (SCD) among children at Mulago Hospital, Kampala, Uganda (TUPE074 – Poster Exhibition). B.K. Kasule, G. Tumwine, (Hope for the Disabled Uganda, Kampala, Uganda, Watoto Child Care Ministries, Medical Department, Kampala, Uganda, Makerere University, College of Veterinary Medicine, Animal Resources & Bio-security, Kampala, Uganda).

The prevalence of HIV/AIDS and asymptomatic malaria in children attending SCD clinic were quite high with the former exceeding the national prevalence supporting the view than Ugandan children with SCD die before five years. Children were significantly stunted and underdeveloped which could have made them prone to increased clinic visits. National health programmes should focus on the health needs of children with SCD by integrating HIV/AIDS care, nutritional therapy, and malaria control programmes.

3. Technical support (TS) needs of countries for preparation of funding requests under the Global Fund’s new funding model (NFM) (THPE427 – Poster Exhibition). A. Nitzsche-Bell, B. Hersh (UNAIDS, Geneva, Switzerland).

The results of this survey suggest that there is very high demand GF funding in 2014 and a concomitant high demand for TS to assist in the preparation of funding requests. TS priority needs span across different technical, programmatic and management areas. Increased availability of funding for TS and enhanced partner coordination through the Country Dialogue process are needed to ensure that countries have access to timely, demand-driven, and high-quality TS to maximize mobilization of GF resources under the NFM.

4. Optimizing the efficiency of integrated service delivery systems within the existing scaled-up community health strategy in Kenya: pathfinder/USAID/APHIAplus Nairobi-Coast program experience (THPE351 – Poster Exhibition). V. Achieng Ouma, D.M. Mwakangalu, P. Eerens, J. Mwitari, E. Mokaya, J. Aungo Bwo’nderi, S. Naketo Konah (Pathfinder International, Nairobi, Kenya, Pathfinder International, Service Delivery, Mombasa, Kenya, Ministry of Health, Division of Community Health Strategy, Nairobi, Kenya, Pathfinder International, Research and Metrics/Strategic Information Hub, Nairobi, Kenya, University of Portsmouth, Geography, Portsmouth, United Kingdom).

APHIAplus (a USAID sponsored health program in Kenya) supports the implementation of integrated government strategies that center around HIV, AIDS, and tuberculosis prevention, treatment, and care; integrated reproductive health and family planning services; and integrated malaria prevention and maternal and newborn health services. Lessons learned include the finding that integrated outreach holds potential to meet clients’ needs in an efficient, effective manner. For example, during a single contact with a service provider, a mother obtains immunization services and growth monitoring for her infant, counseling and testing for HIV, counseling on family planning, cervical cancer screening, and treatment of minor ailments. Results indicate better integration of HIV prevention, care, and treatment within complementary efforts that address key drivers of mortality and morbidity. Success in integration was fostered by a stronger focus on outcomes throughout the APHIAplus implementation cycle.

5. Long term outcomes of HIV-infected Malawian infants started on antiretroviral therapy while hospitalized (THPE070 – Poster Exhibition). A. Bhalakia, M. Bvumbwe, G.A. Preidis, P.N. Kazembe, N. Esteban-Cruciani, M.C. Hosseinipour, E.D. Mccollum (Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Pediatrics, Bronx, United States, Baylor College of Medicine Abbott-Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi, Baylor College of Medicine, Pediatrics, Houston, United States, University of North Carolina Project, Lilongwe, Malawi, Johns Hopkins School of Medicine, Pediatrics, Division of Pulmonology, Baltimore, United States).

One-year retention rates of HIV-infected infants diagnosed and started on ART in the hospital setting are comparable to outpatient ART initiations in other Sub-Saharan countries. Further studies are needed to determine if inpatient diagnosis and ART initiation can provide additional benefit to this population, a subset of patients with otherwise extremely high mortality rates.  Of the 16 children who died, median time from ART initiation to death was 2.7 months. Causes of death include pneumonia, diarrhea, fever, anemia, malnutrition, malaria and tuberculosis.

6. Killing three birds with one stone: integrated community based approach for increasing access to AIDS, TB and Malaria services in Oyo and Osun States of Nigeria (MOPE435 – Poster Exhibition). O. Oladapo, E. Olashore, K. Onawola, M. Ijidale. (PLAN Health Advocacy and Development Foundation, Programs, Ibadan, Nigeria, Civil Society for the Eradication of Tuberculosis in Nigeria, Programs, Ibadan, Nigeria, Community and Child Health Initiative (CCHI), Programs, Ibadan, Nigeria, Community Health Focus (CHeF), Programs, Ibadan, Nigeria).

Community Systems Strengthening (CSS) is a tested and successful strategy for providing integrated AIDS, TB and Malaria (ATM) services in resource-limited settings. 20 selected community based organizations (CBOs) working on at least one of AIDS, TB or Malaria were trained by PLAN Foundation on basics of ATM-related project management including monitoring and evaluation; demand generation through active referrals; and community outreaches. Empowering CBOs is an effective and low-cost strategy for increasing demand for ATM services in resource-limited settings. Integrating referral for ATM services increases effectiveness of and public confidence in primary healthcare services at the grassroots.

7. (Upcoming on 21st July) The health impact of a program to integrate household water treatment, hand washing promotion, insecticide-treated bed nets, and pediatric play activities into pediatric HIV care in Mombasa, Kenya (MOAE0104 – Oral Abstract Session). N. Sugar, K. Schilling, S. Sivapalasingam, A. Ahmed, D. Ngui, R. Quick. (Project Sunshine, New York, United States, U.S. Centers for Disease Control and Prevention, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections, CDC, Atlanta, United States, New York University, New York, United States, Bomu Hospital, Mombasa, Kenya).

Jhpiego and partners have been implementing USAID’s Improving Malaria Care (IMC) project in Burkina Faso for the past 9 months. In the paragraphs below, the team in Ouagadougou has reported their experiences in improving the quality of malaria data reported from the district level. Good quality data are needed to identify challenges and successes and make decisions for future malaria programming

IMC involves data collectors (Healthcare providers) directly in the data validation process. Previously, the malaria data validation was supported by the Global Funds and was done at the Regional level. The new approach proposed by IMC is to organize malaria data validation at district level where the healthcare providers who continuously collect data, can participate in the data validation meetings.

The pilot phase was conducted in the first 20 supported Health Districts in April (14^th – 18^th). In total, 520 healthcare providers attended the data validation meetings across 20 Health Districts. The most important lessons learnt are following:

1. The involvement of the primary data collectors (Healthcare providers) in this activity reinforced their capacity to improve data quality;
2. The correction of the mistakes made during these meeting have been integrated in the national database (BD_Malaria);
3. This was another opportunity to explain the key indicators of malaria and how to control the data quality inside of the Health Facility;
4. Based on the quantity of the mistakes noted during these data validation meetings in only 20 Health Districts (20 of 63 HD), we can affirm that these are some important data quality issues.

Dr Kam Semon, District Medical Officer of Banfora Health District, after the Data validation workshop shared his views of the experience.

“Firstly, allow me to thank Jhpiego for his permanent assistance and innovation regarding healthcare management. I have appreciated the new approach developed by Jhpiego to ensure data quality. During this meeting I have noted that they are lot of mistakes in the data we used to plan and to make decision.

“I have noted that the Data manager at District level and healthcare providers (who collect routine data) have to work very closely to improve and ensure data quality. That means we have to more involve the Data Manager of District in the regular supervision visits. […] I promised you to use the new approach for all health data validation.

“I will discuss with my team, to include the data validation using that new approach in our quarterly health management meeting. I would like to thank Jhpiego once again. I also thank USAID for his financial support to the IMC project. “