Posts or Comments 03 December 2021

Archive for "Community"



Antenatal Care (ANC) &Communication &Community &COVID-19 &IPTp &Malaria in Pregnancy &mHealth Bill Brieger | 18 Nov 2021

SMS to support health worker knowledge retention of maternal health and malaria interventions

The TiPToP malaria in pregnancy project of Jhpiego and Unitaid has been adjusting to the COVID-19 pandemic. Their abstract below is being presented at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting and explains the use of bulk SMS to support health worker knowledge retention on antenatal care and the use of intermittent preventive treatment of malaria in pregnancy during COVID-19 in Bosso local government area of Niger State, Nigeria. See Author List below.

In light of COVID-19 travel restrictions, bulk SMS were used to support knowledge retention of health workers following an in-person training held before the pandemic. In December 2019, 72 facility health workers and 260 community health workers (CHWs) in Bosso local government area of Niger State, Nigeria participated in a 12-day training about benefits of early antenatal care (ANC) attendance, CHW referrals to ANC, and use of intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine to prevent malaria.

In-person supervision visits were conducted 3 months following training, although three months later in-person supervision was no longer possible due to COVID-19 related travel restrictions. Post-training support transitioned to use of bulk SMS which were sent twice a week to each cadre for two 3-month rounds of messaging.

Knowledge tests comprised of 10 multiple choice questions linked to key ANC and IPTp guidelines were administered at 5 time points: 1) baseline; 2) post-training; 3) at in-person supervision visit 3 months after training; 4) after first round of bulk SMS (6 months post-training); and 5) after second round of bulk SMS (9 months post-training).

Average test scores for each cadre were calculated at each time point and T-tests were used to assess differences in scores. The results show that facility health workers scored an average of 53% on the pre-test followed by scores of 76%, 74%, 86%, and ending at 80% 9 months following training. CHWs started with an average score of 49% which increased to 67% post-training; subsequent average scores were 83%, 74%, and 94%.

Results were compelling with facility health worker knowledge improving from 76% immediately post-training to 80% 9 months later (p-value<0.05) and for CHWs the improvement was from 67% to 94% (p-value<0.05). These findings suggest that use of SMS can support knowledge retention of key ANC and IPTp guidelines following an in-person training. Program managers, trainers and supervisors may consider using this approach to support health workers where resources and/or movement are restricted.

AUTHOR INFORMATION:

Charity Anoke 1, Orji Bright 1, Joseph Enne 1, Bartholomew Odio 1, Christina Maly 2, Amina Zimro 3, Ibrahim Idris 3, Elizabeth Njoku 1, Oniyire Adetiloye 1, Emmanuel Dipo Otolorin 1, Elaine Roman 2  — 1Jhpiego, Abuja, Nigeria, 2Jhpiego, Baltimore, MD, United States, 3Niger State Ministry of Health, Minna, Nigeria

Community &Diagnosis &Guidelines &Health Workers &IPTp &Malaria in Pregnancy &Monitoring &Treatment Bill Brieger | 02 Nov 2021

Updating Malaria Guidelines and Tools: The Kenya Example

Kenya Division of National Malaria Program (DNMP) with support from PMI Impact Malaria (IM) and in collaboration with other stakeholders reviewed/developed/updated nine key program documents. Agustine Ngindu and the Impact Malaria/PMI team stress the importance of keeping key malaria technical guidance and tools up-to-date.

Guidelines for the Diagnosis, Treatment, and Prevention of Malaria in Kenya was revised to indicate the start of IPTp at 13 weeks from the prior recommendation of 16 weeks of gestation and updated the IPTp schedule in line with WHO guidance. The program also updated dosing charts for artemether lumefantrine, dihydroartemisinin-piperaquine, and injectable artesunate to include both weight and age range particulars. This update will enhance adherence to treatment guidelines among healthcare workers

The Kenya Quality Assurance Guidelines for Parasitological Diagnosis of Malaria was in draft form for nearly 10 years. Revisions were motivated by the lack of a functional quality assurance (QA)/quality control (QC) system for malaria diagnosis. Sections were added to guide implementation of internal quality control and external quality assurance programs. Updates also provided guidance on surveys to determine the extent of gene deletion and its effect on routine RDT-based malaria diagnosis.

Implementation Framework for Malaria Rapid Diagnostic Tests was developed to facilitate rollout of malaria diagnostics QA/QC in line with Kenya Malaria Strategy (KMS) of 2019-2023. As p[art of this effort, the M&E framework was expanded to include the performance matrix. A costed implementation matrix to provide guidance was developed on costing of activities in line with KMS 2019-2023.

Biosafety Guidelines for Malaria Rapid Diagnostic Testing at Community Level was highlighted in new guidelines developed to address emerging QA and biosafety concerns at community level. This was a response to requirements by the Kenya Medical Laboratory Technicians and Technologists Board to allow for a new waiver for community health volunteers (CHVs) to conduct testing using mRDTs.

The Guidelines on Community Case Management of malaria and its implementation plan were strengthened as was the Implementation framework for Rapid Diagnostic Testing. Updated job aids included dosing schedules for artemether lumefantrine (AL) and injectable artesunate for use at service delivery points by Health Care Workers in line with the revised guidelines.

Hopefully all national malaria programs will take the Kenya experience as an example of the need to update regularly all the tools needed for front line staff to achieve malaria elimination.

Capacity Building &CHW &Community &Elimination &Health Education &Indoor Residual Spraying &IPTp &ITNs &Malaria in Pregnancy &World Malaria Day &Zero Malaria Bill Brieger | 25 Apr 2021

Twenty Years of Malaria Day Observances: Jhpiego at the Forefront

In 2001 the first Africa Malaria Day (AMD) was observed. The opportunity to mark progress and exhort increased efforts for the continent continued through 2007. Then in 2008, the concept of World Malaria Day (WMD) took over, though it could not be denied that the bulk of malaria morbidity, mortality and intervention still was focused on African countries. Other countries have made progress such as the recent certification of malaria elimination in Argentina and El Salvador, but twenty years after the first AMD/WMD, Africa is still leading the way for creative, sustained intervention against the disease, despite threats to resources from economic downturns and new pandemic diseases.

Below we go straight to Africa to share activities and observances of WMD 2021 from Jhpiego’s African Malaria Technical Officers. After reading through, please watch “Jhpiego Leaves No One Behind | World Malaria Day, 2021″ on YouTube.

“Saramed” from Guinea reports that Guinea, like other countries in the world, celebrates World Malaria Day under the theme: ” Zero Malaria, Draw a Line on Malaria “. We are currently conducting the following activities:

  • Lectures and debates on malaria in medical faculties and health schools;
  • Animation of debate programs on malaria in public and private radios and televisions of the country,
  • Advocacy and sensitization of religious and other influential people
  • Carrying out a package of activities (administration of IPT to pregnant women who have missed their ANC appointment, community distribution of LLINs, screening and treatment of confirmed cases, awareness raising on malaria) in high incidence localities.

These activities is in line with the WHO approach of “high burden, high impact”.

Noella Umulisa reports that the WMD celebration took place in Eastern Province, in Bugesera district in the Mareba sector. Due to COVID-19 pandemic ,only 100 persons were invited to the event.This year’s the national theme is “Zero Malaria starts with me”.

Key activities during the event included …

  • Visit of breeding sites under sentinel surveillance
  • Visit of indoor residual spraying (IRS) sites
  • Launching of the Awareness of the population using drones on the ongoing IRS campaign in this time of COVID-19
  • Song by CHWs
  • Certificate to Integrated Vector Management (IVM) Training of Trainers who will train others up to village level
  • Speech of the Director General ,the guest of honor.

From Burkina Faso, Yousseff Sawadogo and Moumouni Bonkoungou shared photos of the celebration that featured a giant Insecticide-Treated  Net, a speech by the US Ambassador, a malaria song composed by a nurse, an official speech by the President of the National Assembly, and national recognition given to one of the current Jhpiego staff members, Thiery Ouedraogo, who at one time also served as director of the national malaria control program. He was decorated by the country’s authorities as a knight of the order of merit.

Bright Orgi from Jhpiego’s TiPToP malaria in pregnancy project in Nigeria ?? shared photos from a series of compound meetings in the community to mark WMD 2021. The meetings focused on malaria prevention and treatment. Provided opportunities to rural communities to ask questions on malaria issues. Here we can see that observance of WMD must be taken to the people who actually suffer from malaria and need to be actively involved in its solution. Deo Cibinda from the Democratic Republic of the Congo share photos of a national celebration, seen to the left.

Finally, As Kristen Vibbert noted, “These are such amazing World Malaria Day stories. I’m so heartened to see all of these great country efforts to remind everyone of how the fight against malaria must continue despite the Covid-19 pandemic.”  Charles Wanga tweeted, “We know how to defeat #malaria. But that’s not enough. We must do more to save pregnant women and children from the deadly scourge. This #WorldMalariaDay and everyday, because@Jhpiego leaves no one behind in our fight to #EndMalaria for good in Africa, and everywhere”

Communication &Community &IPTp &Malaria in Pregnancy Bill Brieger | 17 Nov 2020

What could hinder IPTp uptake?

Cristina Enguita-Fernàndez and colleagues share findings on from a qualitative study on the acceptability of a community-based approach to IPTp delivery in 4 sub-Saharan countries in the UNITAID TiPTop project. Their poster is available at the vitrual 69th Annual Meeting of American Society of Tropical Medicine and Hygiene.

Increasing uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is key to improving maternal health indicators in malaria endemic countries, yet current coverage rates remain low. This qualitative study is part of a project evaluating the acceptability of a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in 4 countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria.

Between March 2018 and February 2020 a total of 435 in-depth interviews and 181 focus group discussions were carried out in the four country sites with pregnant women, relatives, women of reproductive age, community leaders, CHWs, and health providers. These were combined with direct observations of both community and facility based IPTp delivery.

Grounded theory guided the study design and data collection, and data were analysed following a combination of content and thematic analysis to identify barriers to IPTp uptake. Although the novel C-IPTp intervention overcomes some access barriers (such as distance from health care providers, and travel costs), the study identified important barriers, some of which cut across delivery mechanisms and others that are specific to the C-IPTp approach.

Cross-cutting barriers consisted of perceived attributes of SP that explain treatment refusal. These consisted of sensorial characteristics, including the drug’s perceived foul smell, taste and large size; experiences with adverse drug effects, such as nausea and weakness; fears of adverse pregnancy outcomes, such as miscarriages or oversized babies leading to C-sections.

Attributes originated either in individual experiences of SP intake or were socially transmitted. Barriers specific to C-IPTp were centered around concerns over trust in CHWs as adequate providers of maternal healthcare and their competence in delivering IPTp. Despite sensitization activities, misinformation could still be determining these barriers. Ensuring an improved awareness of SP effects and its use, as well as a better understanding of the intervention should lead to enhanced C-IPTp adherence

Authors and Affiliations

Cristina Enguita-Fernàndez1, Yara Alonso1, Wade Lusengi2, Alain Mayembe2, Aimée M. Rasoamananjaranahary3, Estêvão Mucavele4, Ogonna Nwankwo5, Elaine Roman6, Franco Pagnoni1, Clara Menéndez1, Khátia Munguambe4 – 1ISGlobal – Barcelona Institute for Global Health, Barcelona, Spain, 2Bureau d’Étude et de Gestion de l’Information Statistique, Kinshasa, Congo, Democratic Republic of the, 3Malagasy Associates for Numerical Information and Statistical Analysis, Antananarivo, Madagascar, 4Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique, 5University of Calabar, Calabar, Nigeria, 6Jhpiego, affiliate of Johns Hopkins University, Baltimore, MD, United States

CHW &Community &IPTp &Malaria in Pregnancy Bill Brieger | 16 Nov 2020

Community health workers’ sex and variation in uptake of malaria in pregnancy services in Ebonyi State, Nigeria

Ebonyi members of Integrated Health Data Management Team (IHDTM) providing mentorship to HCWs during RDQA visit to Akpaka

Bartholomew Odio et al. work with CHWs who promote community delivery of intermittent preventive treatment for pregnant women in Ebonyi State, Nigeria for the UNITAID/Jhpiego TiPToP Project. They shared below some of their findings from the virtual 69th Annual Meeting of American Society of Tropical Medicine and Hygiene this week. (Photos are from Bright Orji)

In Nigeria, malaria remains a high burden disease and pregnant women are among the most vulnerable. According to the 2019, World Malaria Report only 31% of pregnant women received the World Health

CHWs at data validation meeting during COVID 19 pandemic social distancing

Organization recommended minimum of three doses of IPTp with Sulfadoxine-Pyrimethamine (SP) compared to 17% in Nigeria (DHS, 2018). In order to expand the coverage of this life-saving intervention, the Transforming Intermittent Preventive Treatment for Optimal Pregnancy project engaged community health workers (CHWs) to introduce the delivery of community IPTp (C-IPTp) to eligible pregnant women, in addition to women being able to access IPTp at antenatal care in Ohaukwu district of Ebonyi State, Nigeria.

Community meeting in Bosso

As findings from studies in Nepal and Uganda showed that the sex of CHWs were correlated with uptake of iCCM services, we examined routine project data to determine if the sex of the CHWs was correlated with uptake of IPTp. Of the 462 CHWs selected, 49% were male and 51% were female and were deployed at a ratio of one CHW to 27 pregnant women. All CHWs were trained on early identification of pregnant women, referral to antenatal care and provision of C-IPTp using SP.

A trained data analyst extracted routine data from the national community health management information system for 13,733 pregnant women who received IPTp from CHWs between June and November 2019. Data abstracted included CHW sex and number of PW that received IPTp. Findings showed that female CHWs distributed 60% of IPTp1, 65% IPTp2, and 61% IPTp3 (p-value=0.00 for all comparisons). The data suggest that trained female CHWs may reach more pregnant women than their male counterparts in community directed IPTp interventions.

Authors and Affiliations

Bartholomew Odio(1), Onyinye Udenze(1), Chinyere Nwani(1), Herbert Onuoha(1), Elizabeth Njoku(1), Lawrence Nwankwo(2), Oniyire Adetiloye(1), Bright Orji(1) 1.Jhpiego, Nigeria, Abuja, Nigeria, 2.State Ministry of Health, Nigeria, Abuja, Nigeria. This is part of the TiPToP Project funded by UNITAID.

Cholera &commodities &Community &coronavirus &Costs &COVID-19 &Culture &Epidemiology &Guidelines &Health Systems &HIV &Microscopy &Mosquitoes &Plasmodium/Parasite &Refugee &Sahel &Seasonal Malaria Chemoprevention &Surveillance &Tuberculosis Bill Brieger | 22 Sep 2020

Malaria News Today 2020-09-22: covering three continents

Today’s stories cover three continents including Surveillance for imported malaria in Sri Lanka, community perceptions in Colombia and Annual Fluctuations in Malaria Transmission Intensity in 5 sub-Saharan countries. In addition there is an overview of microscopy standards and an Integrated Macroeconomic Epidemiological Demographic Model to aid in planning malaria elimination. We also see how COVID-19 is disturbing Seasonal Malaria Chemoprevention activities in Burkina Faso. Read more by following the links in the sections below.

Will More of the Same Achieve Malaria Elimination?

Results from an Integrated Macroeconomic Epidemiological Demographic Model. Historic levels of funding have reduced the global burden of malaria in recent years. Questions remain, however, as to whether scaling up interventions, in parallel with economic growth, has made malaria elimination more likely today than previously. The consequences of “trying but failing” to eliminate malaria are also uncertain. Reduced malaria exposure decreases the acquisition of semi-immunity during childhood, a necessary phase of the immunological transition that occurs on the pathway to malaria elimination. During this transitional period, the risk of malaria resurgence increases as proportionately more individuals across all age-groups are less able to manage infections by immune response alone. We developed a robust model that integrates the effects of malaria transmission, demography, and macroeconomics in the context of Plasmodium falciparum malaria within a hyperendemic environment.

The authors analyzed the potential for existing interventions, alongside economic development, to achieve malaria elimination. Simulation results indicate that a 2% increase in future economic growth will increase the US$5.1 billion cumulative economic burden of malaria in Ghana to US$7.2 billion, although increasing regional insecticide-treated net coverage rates by 25% will lower malaria reproduction numbers by just 9%, reduce population-wide morbidity by ?0.1%, and reduce prevalence from 54% to 46% by 2034. As scaling up current malaria control tools, combined with economic growth, will be insufficient to interrupt malaria transmission in Ghana, high levels of malaria control should be maintained and investment in research and development should be increased to maintain the gains of the past decade and to minimize the risk of resurgence, as transmission drops. © The American Society of Tropical Medicine and Hygiene [open-access]

Microscopy standards to harmonise methods for malaria clinical research studies

Research Malaria Microscopy Standards (ReMMS) applicable to malaria clinical research studies have been published in Malaria Journal. The paper describes the rationale for proposed standards to prepare, stain and examine blood films for malaria parasites. The standards complement the methods manual(link is external) previously published by the World Health Organization and UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). The standards aim to promote consistency and comparability of data from microscopy performed for malaria research and hence to strengthen evidence for improvements in malaria prevention, diagnostics and treatment.

Microscopy is important in both malaria diagnosis and research. It is used to differentiate between Plasmodium species and stages and to estimate parasite density in the blood – an important determinant of the severity of disease. It is also used to monitor the effectiveness of drugs based on the rate at which parasites recrudesce or are cleared from the blood.

While rapid diagnostic tests have replaced microscopy in some contexts, microscopy remains an essential tool to support clinical diagnosis and research. The standardisation of methods allows direct comparisons from studies conducted across different points in time and location. This facilitates individual participant data meta-analyses, recognised as the gold standard approach to generate evidence for improvements in interventions and hence patient outcomes.

Estimating Annual Fluctuations in Malaria Transmission Intensity and in the Use of Malaria Control Interventions in Five Sub-Saharan African Countries

RTS,S/AS01E malaria vaccine safety, effectiveness, and impact will be assessed in pre- and post-vaccine introduction studies, comparing the occurrence of malaria cases and adverse events in vaccinated versus unvaccinated children. Because those comparisons may be confounded by potential year-to-year fluctuations in malaria transmission intensity and malaria control intervention usage, the latter should be carefully monitored to adequately adjust the analyses. This observational cross-sectional study is assessing Plasmodium falciparum parasite prevalence (PfPR) and malaria control intervention usage over nine annual surveys performed at peak parasite transmission. Plasmodium falciparum parasite prevalence was measured by microscopy and nucleic acid amplification test (quantitative PCR) in parallel in all participants, and defined as the proportion of infected participants among participants tested. Results of surveys 1 (S1) and 2 (S2), conducted in five sub-Saharan African countries, including some participating in the Malaria Vaccine Implementation Programme (MVIP), are reported herein; 4,208 and 4,199 children were, respectively, included in the analyses.

Plasmodium falciparum parasite prevalence estimated using microscopy varied between study sites in both surveys, with the lowest prevalence in Senegalese sites and the highest in Burkina Faso. In sites located in the MVIP areas (Kintampo and Kombewa), PfPR in children aged 6 months to 4 years ranged from 24.8% to 27.3%, depending on the study site and the survey. Overall, 89.5% and 86.4% of children used a bednet in S1 and S2, of whom 68.7% and 77.9% used impregnated bednets. No major difference was observed between the two surveys in terms of PfPR or use of malaria control interventions. © The American Society of Tropical Medicine and Hygiene [open-access]

Community perception of malaria in a vulnerable municipality in the Colombian Pacific

Malaria primarily affects populations living in poor socioeconomic conditions, with limited access to basic services, deteriorating environmental conditions, and barriers to accessing health services. Control programmes are designed without participation from the communities involved, ignoring local knowledge and sociopolitical and cultural dynamics surrounding their main health problems, which implies imposing decontextualized control measures that reduce coverage and the impact of interventions. The objective of this study was to determine the community perception of malaria in the municipality of Olaya Herrera in the Colombian Pacific.

A 41-question survey on knowledge, attitudes, and practices (KAP) related to malaria, the perception of actions by the Department of Health, and access to the health services network was conducted. In spite of the knowledge about malaria and the efforts of the Department of Health to prevent it, the community actions do not seem to be consistent with this knowledge, as the number of cases of malaria is still high in the area.

Use of a Plasmodium vivax genetic barcode for genomic surveillance and parasite tracking in Sri Lanka

Sri Lanka was certified as a malaria-free nation in 2016; however, imported malaria cases continue to be reported. Evidence-based information on the genetic structure/diversity of the parasite populations is useful to understand the population history, assess the trends in transmission patterns, as well as to predict threatening phenotypes that may be introduced and spread in parasite populations disrupting elimination programmes. This study used a previously developed Plasmodium vivax single nucleotide polymorphism (SNP) barcode to evaluate the population dynamics of P. vivax parasite isolates from Sri Lanka and to assess the ability of the SNP barcode for tracking the parasites to its origin.

A total of 51 P. vivax samples collected during 2005–2011, mainly from three provinces of the country, were genotyped for 40 previously identified P. vivax SNPs using a high-resolution melting (HRM), single-nucleotide barcode method. The proportion of multi-clone infections was significantly higher in isolates collected during an infection outbreak in year 2007. Plasmodium vivax parasite isolates collected during a disease outbreak in year 2007 were more genetically diverse compared to those collected from other years. In-silico analysis using the 40 SNP barcode is a useful tool to track the origin of an isolate of uncertain origin, especially to differentiate indigenous from imported cases. However, an extended barcode with more SNPs may be needed to distinguish highly clonal populations within the country.

Coronavirus rumours and regulations mar Burkina Faso’s malaria fight

By Sam Mednick, Thomson Reuters Foundation: MOAGA, Burkina Faso – Health worker Estelle Sanon would hold the 18-month-old and administer the SMC dose herself, but because of coronavirus she has to keep a distance from her patients. “If I am standing and watching the mother do it, it’s as if I’m not doing my work,” said Sanon, a community health volunteer assisting in a seasonal campaign to protect children in the West African country from the deadly mosquito-borne disease.

Burkina Faso is one of the 10 worst malaria-affected nations in the world, accounting for 3% of the estimated 405,000 malaria deaths globally in 2018, according to the World Health Organization (WHO). More than two-thirds of victims are children under five. Now there are fears malaria cases could rise in Burkina Faso as restrictions due to coronavirus slow down a mass treatment campaign and rumours over the virus causing parents to hide their children, according to health workers and aid officials.

“COVID-19 has the potential to worsen Burkina Faso’s malaria burden,” said Donald Brooks, head of the U.S. aid group Initiative: Eau, who has worked on several public health campaigns in the country.  “If preventative campaigns can’t be thoroughly carried out and if people are too scared to come to health centres … it could certainly increase the number of severe cases and the risk of poor outcomes.”

During peak malaria season, from July to November, community health workers deploy across Burkina Faso to treat children with seasonal malaria chemoprevention (SMC). This is the second year the campaign will cover the whole country with more than 50,000 volunteers going door-to-door, said Gauthier Tougri, coordinator for the country’s anti-malaria programme. Logistics were already challenging. Violence linked to jihadists and local militias has forced more than one million people to flee their homes, shuttered health clinics and made large swathes of land inaccessible. Now the coronavirus has made the task even harder, health workers said.

People in Cape Verde evolved better malaria resistance in 550 years

Yes, we are still evolving. And one of the strongest examples of recent evolution in people has been found on the Cape Verde islands in the Atlantic, where a gene variant conferring a form of malaria resistance has become more common.

Portuguese voyagers settled the uninhabited islands in 1462, bringing slaves from Africa with them. Most of the archipelago’s half a million inhabitants are descended from these peoples. Most people of West African origin have a variant in a gene called DARC that protects.

Deadly malaria and cholera outbreaks grow amongst refugees as COVID pandemic strains health systems.

Apart from the strain on health facilities during the pandemic, in some countries such as Somalia, Kenya and Sierra Leone, we are seeing that a fear of exposure to COVID-19 has prevented parents from taking their children to hospital, delaying diagnosis and treatment of malaria and increasing preventable deaths. COVID restrictions in some countries have also meant pregnant women have missed antimalarial drugs. Untreated malaria in pregnant women can increase the risk of anaemia, premature births, low birth weight and infant death. According to the World Health Organization (WHO), 80% of programs designed to fight HIV, tuberculosis and malaria have been disrupted due to the pandemic and 46% of 68 countries report experiencing disruptions in the treatment and diagnosis of malaria.

Community &COVID-19 &Infection Prevention &Innovation &Zoonoses Bill Brieger | 10 Sep 2020

Innovate4AMR emphasizes social innovations in resource-limited settings

From Innovate4AMR Team: We are reaching out about Innovate4Health, a global design sprint for student teams to design innovative solutions to address emerging infectious diseases.
This collaborative design sprint grows out of our past two years’ worth of work organizing Innovate4AMR. With COVID-19, we have broadened the scope from drug-resistant infections to tackling urgent challenges and health inequities of emerging infectious diseases. Organized by the ReAct—Action on Antibiotic Resistance, the International Federation of Medical Students’ Associations (IFMSA), and the IDEA (Innovation + Design Enabling Access) Initiative at the Johns Hopkins Bloomberg School of Public Health, Innovate4Health offers student teams the opportunity to join the front lines of the fight against antimicrobial resistance and COVID-19.
This year, student teams are encouraged to innovate around one of three pillars: 1) Ensuring effective prevention and treatment of emerging infectious diseases in the hospital setting; 2) Preventing zoonotic disease transmission in food systems; and 3) Making community health systems more resilient to emerging infectious diseases. We hope that you might pass this along to faculty colleagues at universities and share this opportunity with potentially interested students.
Taking a systems approach, Innovate4Health emphasizes social innovations that consider the needs of resource-limited settings. We are looking for student teams (2-4 students per team) with ideas for innovative solutions. Through the design sprint, teams will work through ideation, implementation, and advocacy strategies to support the adoption of these approaches. The selected teams will work with a team of experts to co-construct their solutions through both recorded and live learning sessions. We invite applications from teams that would be excited to collaborate with other highly talented student teams.
The design sprint will extend over three to four months. We will explore the local context of resource-limited settings through guided tours through virtual healthscapes, from a wet market to a secondary hospital.
Students do not need any previous experience on antimicrobial resistance (AMR) or other emerging infectious diseases. In the competitive application process, we are looking for student teams providing a vision for what they might want to innovate, including the specific problem and context, as well as sharing how they might be positioned to help implement such a project.
At the application stage, however, we do not expect fully developed projects. The design sprint process is intended to help teams develop further their ideas from the application stage. Innocate4AMR have outlined additional information on Innovate4Health on our website. There, you will also find more background information on Innovate4Health, as well as the design sprint timeline, Terms and Conditions, and submission guidelines. Last year, 163 student teams answered our call for Innovate4AMR applications, and ten finalist teams were selected.
The deadline for team applications is Sunday, October 18, 2020. Those selected to participate in the design sprint will go through developing stages of idea refinement, implementation planning, and advocacy planning, after which the best teams will have the opportunity to present to an international panel. We will be releasing additional resources to support teams in developing applications, and interested students can sign up for updates here.
Innovate4AMR would appreciate your help in spreading the word about Innovate4Health. If you or your students have further questions, please write our team at innovate4amr@gmail.com.
 

Community &COVID-19 &Dracunculiasis Guinea Worm &Elimination &Integration &NTDs &Snakebite &Surveillance Bill Brieger | 19 May 2020

Tropical Diseases and the World Health Assembly 73rd Meeting

If it were not difficult enough to guide global health during a pandemic, some world leaders are trying to deflect attention from the real dangers at hand to score on their petty political concerns. In the meantime, we need to focus on what tropical health and disease issues may actually be coming under consideration at the virtual WHA 73.

Agenda item 3 (A73/CONF./1 Rev.1) or “COVID-19 response Draft resolution” directly addresses the concerns of many that other major deadly diseases and essential services should not be further neglected. The large group of resolution proponents urge countries and organizations to,

“Maintain the continued functioning of the health system in all relevant aspects, in accordance with national context and priorities, necessary for an effective public health response to the COVID-19 pandemic and other ongoing epidemics, and the uninterrupted and safe provision of population and individual level services, for, among others, communicable diseases, including by undisrupted vaccination programmes, neglected tropical diseases, noncommunicable diseases, mental health, mother and child health and sexual and reproductive health and promote improved nutrition for women and children, recognizing in this regard the importance of increased domestic financing and development assistance where needed in the context of achieving UHC.”

In Provisional agenda item 23 (A73/32) “Progress reports by the Director-General” we find updates on guinea worm eradication and the burden of snakebite envenoming. The report notes the situation in 2019, which is a far cry from the millions of cases in the 1980d when the dracunculiasis eradication effort was launched. “In 2019, three countries reported a total of 53 human indigenous cases of dracunculiasis (guinea-worm disease), namely, Angola (one case), Chad (48 cases) and South Sudan (four cases), from a total of 28 villages. Cameroon reported one human case, probably imported from Chad.”

It is important to note that, “The global dracunculiasis eradication campaign is based on both community and country-focused interventions,” where community members play an important role in surveillance and notification. This includes at-risk and border areas, as is being done in Cameroon. The challenge of human Dracunculus medinensis infection in dogs continues and points to the importance of One Health in the control and elimination of NTDs. Surveillance is not cheap, and the report stresses that funds are still needed so that international partners can continue to ensure that the last case of guinea worm is detected and contained.

Moving from the smaller serpent to the larger variety, the report recalls the May 2018 World Health Assembly resolution WHA71.5 on addressing the burden of snakebite envenoming. A global strategy, “Snakebite envenoming: a strategy for prevention and control” was launched in  in May 2019. The WHO Secretariat has “fostered international efforts to improve the availability, accessibility and affordability of safe and effective antivenoms for all, through assessments of antivenom manufacturing, training programs and stockpile procedures.

Finally, provisional agenda item 11.8 (A73/8) addresses a “Draft road map for neglected tropical diseases 2021–2030.” This builds on resolution WHA66.12 (2013) on WHO’s earlier road map for accelerating work to overcome the global impact of neglected tropical diseases (2012–2020). The proposed interventions build on important principles including:

  1. Tackling neglected tropical diseases through support of the vision of universal health coverage
  2. Adopting grassroots approaches that enable access to some of the world’s poorest, hard-to reach communities and people affected by complex emergencies
  3. Monitoring progress against neglected tropical diseases as a litmus test of progress towards the achievement of universal health coverage

The report notes that “40 countries, territories and areas have eliminated at least one neglected tropical disease,” most notably dracunculiasis (as mentioned above, lymphatic filariasis and trachoma. Although “substantive progress has been made since 2012, it is evident that not all of the 2020 targets will be met.” Hence, a new draft road map for neglected tropical diseases for 2021–2030 is required. The three pillars supporting the new roadmap are outlined in the attached figure.

It is good to know that the 73rd World Health Assembly will not be completely overshadowed by COVID-19 and politics. Efforts to sustain and improve NTD control and elimination must not be jeopardized.

Community &IPTp &Malaria in Pregnancy Bill Brieger | 14 Mar 2019

Scaling up Malaria in Pregnancy Prevention at the Community Level

Community meeting to introduce community based IPTp

Elaine Roman and Kristin Vibbert of the Jhpiego malaria team describe below an important community-based intervention to prevent malaria in pregnancy. Follow their links to learn more.

The World Health Organization (WHO) 2018 World Malaria Report revealed that of 33 countries where intermittent preventive treatment (with sulfadoxine-

Quality Assured SP Packets

pyrimethamine/SP) is recommended for pregnant women, only 22% of eligible pregnant women received three doses of intermittent preventive treatment during pregnancy (IPTp3) with SP in 2017 (). Therefore, it is crucial that innovative interventions to scale up the provision of IPTp are needed to protect lives of mothers, fetuses and newborns.

The Transforming Intermittent Preventive Treatment for Optimal Pregnancy (TIPTOP), a five-year project, is one such innovative effort that aims to contribute to reduced maternal and neonatal mortality in four countries: DRC, Madagascar, Mozambique, and Nigeria by expanding access to quality-assured (QA) SP.

TIPTOP Infographic

The TIPTOP project is implementing a community-based approach to expand coverage of IPTp3 to a minimum of 50% in project areas, helping to reach the hardest-to-reach pregnant women and to ensure there are no missed opportunities for pregnant women to receive QA SP. Through rigorous research and routine monitoring, TIPTOP will generate evidence for WHO to inform a potential policy decision on global intermittent preventive treatment of malaria in pregnancy.

TIPTOP is also setting the stage for scale up, supporting Ministries of Health to pilot test SP distribution at the community level in settings that will not only yield quality data in real-life program settings but also lend to program learning, including documenting best practices and lessons learned. Further, in coordination with Medicines for Malaria Venture (MMV), TIPTOP is creating demand for and expanding access to QA SP.

Now that procurement, training, supervision, community education, monitoring and evaluation systems are nearly built, full implementation on the ground will be phased in over the next few months.

Community &Partnership &Primary Health Care Bill Brieger | 29 Dec 2018

Community Participation for Primary Health Care in Burkina Faso

The history of community intervention in Burkina Faso dates back to immediately after the declaration of Alma Ata in 1978. The first community health experiments were carried out in 1979 with the support various development partners with an aim of reducing maternal and infant morbidity and mortality difficult to access health districts where village birth attendants where been trained, equipped and supervised. Today as a matter of policy, Burkina Faso aims at improving the quality of health services and increasing access to health services through community-based health workers (CBOs), civil society organizations (CSOs), non-governmental organizations (NGOs) and associations implements community intervention strategies. with the full participation of communities.[1]

Community Based Health Agent discusses community health needs with village leaders

Burkina Faso’s draft strategic plan for community health states that, “Community Health is a multi-sectoral and multi-disciplinary collaborative enterprise that uses public health science and some social science approaches to engage and work with communities. Its purpose is to optimize the health and quality of life of all people who live, work in a given community. It is based on community needs, understanding and community priorities for health.”1 Community participation is seen as central to achieving universal health care.

The Ministry of Health1 notes that there has been community participation as part of cost recovery (Bamako Initiative). Communities are part of the management committees set up at the level of the first-level health facilities so that the populations thus participate in the management of health facilities, through these committees. “In recent years, there has been renewed interest in community health with a strong mobilization of civil society through NGOs and associations. Community components are integrated into many health programs. This new dynamic has led to significant progress and positive results in the areas of the fight against HIV, tuberculosis, reproductive health (family planning, health of young people and adolescents), malaria, malnutrition, vaccination, etc.”

The Ministry reports that, “Indeed, the community actors have contributed to the achievement of the results obtained through the implementation of community-based health services, which however remain to be rethought not only in its vision but also to be in phase with that of the universal health coverage. For a better involvement of these actors in the achievement of the health objectives, the main challenges remain their motivation, the reinforcement of their capacities and the collaboration with the agents of health.”1 Systematic evaluation of such results remains to be done.

Community Based Health Agents review their service data each month

While there have not been systematic assessments of these participatory processes in community health, researchers did take a close look at the levels and types of community participation attained in water and sanitation projects in Burkina Faso. The following lessons have implications for involving Burkina Faso communities on PHC:[2]

  • Users and Neighborhood groups have a lower level of participation than city and government stakeholders
  • It is possible that the social structures and traditions in Burkina Faso do not encourage a more participative approach
  • Further study of power structures in Burkina Faso may determine why participation is lower than expected
  • There is a significant decrease in participation levels during the design and selection steps of planning as opposed to the earlier stages of problem identification and definiing objectives, and the later stages of option selection and action planning – a question of planning styles dominated by experts

These issues raise questions about the social and cultural aspects of the planning process and about leadership and governance. It would seem that ‘experts’ also need education about how to work with communities.  There are also concerns about the level of community education employed to help community members and CBOs make informed choices. The authors raise another important question concerning expectations that communities will take ownership in the running of projects when in fact these Users have only been asked about their problems and then been informed about a solution.

In another sector the World Food Program developed a diagnostic and planning approach based using community participation and conducted training and practical exercises on “Community-Based Participatory Planning.” The exercise brought many community actors together to identify food security issues such as land degradation, lack of economic activities for residents in the non-agricultural season and floods that block access to health and other services. participators discussions identified community resources to address these issues and demonstrate resilience.[3]

A recent Global Fund grant to Burkina Faso was entitled, “Strengthening health systems and scaling-up of integrated community case management interventions.”[4] Community-based organizations (CBOs) involved in control of the three diseases commonly addressed through integrated Community Case Management (iCCM) – malaria, diarrhea and pneumonia. The program was also expected to strengthen the community workforce be ensuring adequate numbers of functional CHWs. The project received a high level of regular reporting by CBOs (100%), but less than ideal from individual CHWs (83%). This was in spite of the fact that they achieved recruitment targets for ‘functional’ CHWs. Interestingly the biggest problem for the CHWs was the extremely low availability of essential supplies with which they could work (13%). The grant demonstrated the challenges of involving CHWs in more focused activities as opposed to a broader community agenda. Reorganization of the CHW program in the last few years has created a standardized curriculum so that there are two CHWs per village who respond to a variety of community needs ranging from reproductive health to disease control. The problem of adequate supplies and materials to do their work continues, though.

The Village Market provides a good opportunity for community education

While Burkina Faso has established the basic participatory structures in the form of committees and community agents, the Ministry of Health is concerned that Community participation is low.1 Lessons from other sectors show possible reasons and solutions and inter-sectoral collaboration, one of the hallmarks of PHC should be used to address the challenges. the MOH of course has its own ideas (listed below) about the root causes of this problem and having identified the following, it should be encouraged to continue efforts to strengthen the roll of the community in PHC:

  • lack of social capital (capacities of communities to work together effectively, to identify problems, to prioritize and take charge of them)
  • weak involvement of communities in the whole process of implementation.
  • greater focus on community diagnosis of needs, assets, and priorities, to develop appropriate intervention strategies, planning, implementation, evaluation
  • lack of capacity (skills, human resources, material and time) of community implementation actors,
  • lack of accountability of the stakeholders responsible for the implementation of community-based initiatives (CBIs)
  • lack of a multi-sectoral approach in the resolution of health problems

Insufficient strategies to combat social exclusion and to take into account specific groups also constitute a barrier to community participation

Partners worry that there is difficulty sustaining CBIs and demotivation of actors (CHWs, facilitators), which can allow morbidity and mortality to remain high in the community. Clearly, investment in strengthening community participation will go a long way in saving lives and promoting health.


[1] Ministere De La Sante. Draft Strategie Nationale De Sante Communautaire Au Burkina Faso 2019-2023. September 2018

[2] McConville J, Kain J, Kvarnstrom E, et al. (2014) “Participation in sanitation planning in Burkina Faso: theory and practice”. Journal of Water Sanitation and Hygiene for Development, vol. 4(2), pp. 304-312. http://dx.doi.org/10.2166/washdev.2014.125

[3] Ouedraogo, Celestine (2016). Promoting Community-Led Resilience and Development Solutions in Burkina Faso. World Food Program. https://www.wfp.org/stories/promoting-community-led-resilience-and-development-solutions-in-burkina-faso

[4] Global Fund (2017). Burkina Faso BFA-S-PADS Grand Performance Report. https://www.theglobalfund.org/en/portfolio/country/grant/?k=d8f34742-0d57-410c-b5ba-39615edc5785&grant=BFA-S-PADS

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