• Antibiotic Prescribing for Upper Respiratory Infections Among Children in Rural China: a Cross-Sectional Study of Outpatient Prescriptions

      Zhang, Z; Hu, Y; Zou, G; Lin, M; Zeng, J; Deng, S; Zachariah, R; Walley, J; Tucker, JD; Wei, X (Taylor & Francis, 2017-05-02)
      Overuse of antibiotics contributes to the development of antimicrobial resistance.
    • Assessment of household ownership of bed nets in areas with and without artemisinin resistance containment measures in Myanmar

      Maung, TM; Oo, T; Wai, KT; Hlaing, T; Owiti, P; Kumar, B; Shewade, HD; Zachariah, R; Thi, A (BioMed Central, 2018-03-23)
      Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria. As the artemisinin compound is the pillar of effective antimalarial therapies, containing the spread of artemisinin resistance is a national and global priority. The use of insecticide-treated bed nets/long-lasting insecticidal nets (ITNs/LLINs) is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains, and for eventually eliminating malaria. This study aimed at assessing household ownership of, access to, and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures.
    • Building Global Capacity for Conducting Operational Research Using the SORT IT Model: Where and Who?

      Zachariah, R; Rust, S; Berger, SD; Guillerm, N; Bissell, K; Delaunois, P; Reid, AJ; Kumar, AM; Olliaro, PL; Reeder, JC; et al. (Public Library of Science, 2016)
      Research capacity is weakest in low and middle-income countries (LMICs) where operational research is highly relevant and needed. Structured Operational Research and Training Initiative (SORT IT) courses have been developed to train participants to conduct and publish operational research and influence policy and practice. Twenty courses were completed in Asia, Africa, Europe and the South Pacific between 2009 and 2014.
    • Building Global Capacity for Conducting Operational Research Using the SORT IT Model: Where and Who?

      Zachariah, R; Rust, S; Berger, SD; Guillerm, N; Bissell, K; Delaunois, P; Reid, AJ; Kumar, AMV; Olliaro, PL; Reeder, JC; et al. (Public Library of Science, 2016-08-09)
      Research capacity is weakest in low and middle-income countries (LMICs) where operational research is highly relevant and needed. Structured Operational Research and Training Initiative (SORT IT) courses have been developed to train participants to conduct and publish operational research and influence policy and practice. Twenty courses were completed in Asia, Africa, Europe and the South Pacific between 2009 and 2014.
    • Building the capacity of public health programmes to become data rich, information rich and action rich

      Harries, AD; Khogali, M; Kumar, AMV; Satyanarayana, S; Takarinda, KC; Karpati, A; Olliaro, P; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2018-06-21)
      Good quality, timely data are the cornerstone of health systems, but in many countries these data are not used for evidence-informed decision making and/or for improving public health. The SORT IT (Structured Operational Research and Training Initiative) model has, over 8 years, trained health workers in low- and middle-income countries to use data to answer important public health questions by taking research projects through to completion and publication in national or international journals. The D2P (data to policy) training initiative is relatively new, and it teaches health workers how to apply 'decision analysis' and develop policy briefs for policy makers: this includes description of a problem and the available evidence, quantitative comparisons of policy options that take into account predicted health and economic impacts, and political and feasibility assessments. Policies adopted from evidence-based information generated through the SORT IT and D2P approaches can be evaluated to assess their impact, and the cycle repeated to identify and resolve new public health problems. Ministries of Health could benefit from this twin-training approach to make themselves 'data rich, information rich and action rich', and thereby use routinely collected data in a synergistic manner to improve public health policy making and health care delivery.
    • Characteristics, utilisation and influence of viewpoint articles from the Structured Operational Research and Training Initiative (SORT IT) – 2009-2020

      Khogali, M; Tayler-Smith, K; Harries, AD; Zachariah, R; Kumar, A; Davtyan, H; Satyanarayana, S; Denisiuk, O; van Griensven, J; Reid, A; et al. (F1000Research, 2021-03-21)
      Background: The Structured Operational Research and Training Initiative (SORT IT) teaches the practical skills of conducting and publishing operational research (OR) to influence health policy and/or practice. In addition to original research articles, viewpoint articles are also produced and published as secondary outputs of SORT IT courses. We assessed the characteristics, use and influence of viewpoint articles derived from all SORT IT courses. Methods: This was a cross-sectional study involving all published viewpoint articles derived from the SORT IT courses held from August 2009 - March 2020. Characteristics of these papers were sourced from the papers themselves and from SORT-IT members involved in writing the papers. Data on use were sourced from the metrics provided on the online publishing platforms and from Google Scholar. Influence on policy and practice was self-assessed by the authors of the papers and was performed only for papers deemed to be ‘calls for action’. Results: A total of 41 viewpoint papers were published. Of these, 15 (37%) were ‘calls for action’. In total, 31 (76%) were published in open-access journals and the remaining 10 in delayed access journals. In 12 (29%) of the papers, first authors were from low and middle-income countries (LMICs). Female authors (54%) were included in 22, but only four (10%) and two (5%) of first and last authors respectively, were female. Only seven (17%) papers had available data regarding online views and downloads. The median citation score for the papers was four (IQR 1-9). Of the 15 ‘call for action’ papers, six influenced OR capacity building, two influenced policy and practice, and three influenced both OR capacity building within SORT IT and policy and practice. Conclusion: Viewpoint articles generated during SORT IT courses appear to complement original OR studies and are valued contributors to the dissemination of OR practices in LMICs.
    • Childhood Tuberculosis in Dushanbe, Tajikistan

      Pirov, K; Sirojiddinova, U; Bobokhojaev, O; Zachariah, R; Lucenko, I; Mirzoev, A; Suleimenov, S; Dustmatova, Z; Rajabov, A; van den Boom, M; et al. (The World Health Organization, 2016-03)
    • Countrywide audit of multidrug-resistant tuberculosis and treatment outcomes in Mongolia

      Ganzaya, S; Naranbat, N; Bissell, K; Zachariah, R (2013-12-21)
    • Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan

      Khader, A; Ballout, G; Shahin, Y; Hababeh, M; Farajallah, L; Zeiden, W; Abu-Zayed, I; Kochi, A; Harries, A D; Zachariah, R; et al. (International Union Against Tuberculosis and Lung Disease, 2014-03-25)
    • Do Incentivised Community Workers in Informal Settlements Influence Maternal and Infant Health in Urban India?

      Verma, H; Sagili, K; Zachariah, R; Aggarwal, A; Dongre, A; Gupte, H (International Union Against Tuberculosis and Lung Disease, 2017-03-21)
      Setting: The introduction of accredited social health activists (ASHAs, community workers) in the community is encouraged by the Government of India as being of universal benefit for maternal and infant health. Objectives: In two informal settlements in Chandigarh, India, one with ASHAs and the other without, we assessed 1) whether ASHAs influenced certain selected maternal and infant health indicators, and 2) perceptions among women who did not contact the ASHAs. Design: This was a mixed-methods study conducted from April 2013 to March 2016 using quantitative (retrospective programme data) and qualitative (free-listing) components. Results: The increase in institutional deliveries from 2013 to 2015 was marginal, and was similar in both areas (86-99% in the settlement with ASHAs and 88-97% in the settlement without). Bacille Calmette-Guérin and pentavalent vaccination coverage were close to 100% in both areas during the 3 years of the study. Antenatal registration in the first trimester increased from 49% to 52% in the settlement with ASHAs and from 53% to 71% in the settlement without. Between 18% and 35% of women did not complete at least three antenatal visits. 'Not knowing ASHAs' and 'not feeling a need for ASHAs' were the main reasons for not using their services. Conclusion: While success has been achieved for institutional deliveries and immunisation coverage even without the ASHAs, their presence plays an important role in improving antenatal indicators.
    • Does Research Through Structured Operational Research and Training (SORT IT) Courses Impact Policy and Practice?

      Kumar, AMV; Shewade, HD; Tripathy, JP; Guillerm, N; Tayler-Smith, K; Dar Berger, S; Bissell, K; Reid, AJ; Zachariah, R; Harries, AD (Cambridge University Press, 2016-03-21)
    • Does the Structured Operational Research and Training Initiative (SORT IT) continue to influence health policy and/or practice?

      Tripathy, JP; Kumar, AM; Guillerm, N; Berger, SD; Bissell, K; Reid, A; Zachariah, R; Ramsay, A; Harries, AD (Taylor & Francis, 2018-08-01)
      The Structured Operational Research and Training Initiative (SORT IT) is a successful model of integrated operational research and capacity building with about 90% of participants completing the training and publishing in scientific journals.
    • Does training of Health Extension Workers reduce scabies load in district health facilities in rural Ethiopia?

      Gezmu, T; Enbiale, W; Asnakew, M; Bekele, A; Beresaw, G; Nigussie, M; Takarinda, K; Manzi, M; Zachariah, R (Journal of Infection in Developing Countries, 2020-06-30)
      Introduction: In 2017, Ethiopia included scabies management within the responsibility of health extension workers. In Kamba (the intervention district) workers were trained on scabies management. Whereas, in Arba Minch Zuria (the control district) there was no such training. This study assesses whether decentralization of scabies management to communities would reduce the load on health facilities and allow earlier scabies treatment access. Methodology: All individuals presenting with scabies before (January - June 2018) and after (August 2018-January 2019) the introduction of training (July 2018) in Kamba district and the Arba Minch Zuria district were included. We compared between the two districts in the period before and after training, the numbers of scabies cases presenting to health facilities, their demography, clinical characteristics and treatment. Results: There were 1,891 scabies cases in the intervention district and 809 in the control district. Scabies cases declined in the intervention district from 7.6 to 1.6 per 1,000 population (a 4.8-fold reduction). In the control district, scabies cases increased from 1.3 to 2.4 per 1,000 population (a 1.8-fold increase). In intervention district, the proportion of scabies patients with secondary skin infections reduced from 1,227 (78%, n = 1,565) to 156 (48%, n = 326, P < 0.001). In the control district the difference was insignificant 39 (14%, n = 288) to 86 (17%, n = 521, P = 0.2). Conclusions: Introducing trained health extension workers at community level were associated with reductions in health facility load for scabies and secondary infections. This is a wider community health benefit.
    • Driving towards malaria elimination in Botswana by 2018: progress on case-based surveillance, 2013-2014

      Motlaleng, M; Edwards, J; Namboze, J; Butt, W; Moakofhi, K; Obopile, M; Manzi, M; Takarinda, KC; Zachariah, R; Owiti, P; et al. (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Background: Reliable information reporting systems ensure that all malaria cases are tested, treated and tracked to avoid further transmission. Botswana aimed to eliminate malaria by 2018, and surveillance is key. This study focused on assessing the uptake of the new malaria case-based surveillance (CBS) system introduced in 2012, which captures information on malaria cases reported in the Integrated Disease Surveillance and Response (IDSR) system. Methods: This was a retrospective descriptive study based on routine data focusing on Ngami, Chobe and Okavango, three high-risk districts in Botswana. Aggregated data variables were extracted from the IDSR and compared with data from the CBS. Results: The IDSR reported 456 malaria cases in 2013 and 1346 in 2014, of which respectively only 305 and 884 were reported by the CBS. The CBS reported 34% fewer cases than the IDSR system, indicating substantial differences between the two systems. The key malaria indicators with the greatest variability among the districts included in the study were case identification number and date of diagnosis. Conclusion: The IDSR and CBS systems are essential for malaria elimination, as shown by the significant gaps in reporting between the two systems. These findings highlight the need for further investigation into these discrepancies. Strengthening the CBS system will help to reach the objective of malaria elimination in Botswana.
    • The Ebola Outbreak and Staffing in Public Health Facilities in Rural Sierra Leone: Who is Left to do the Job?

      Sylvester Squire, J; Hann, K; Denisiuk, O; Kamara, M; Tamang, D; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: The 82 public health facilities of rural Kailahun District, Sierra Leone. Objective: The 2014-2015 Ebola virus disease outbreak in Sierra Leone led the Ministry of Health and Sanitation and stakeholders to set minimum standards of staffing (medical/non-medical) for a basic package of essential health services (BPEHS). No district-level information exists on staffing levels in relation to the Ebola outbreak. We examined the staffing levels before the Ebola outbreak, during the last month of the outbreak and 4 months after the outbreak, as well as Ebola-related deaths among health care workers (HCWs). Design: This was a retrospective cross-sectional study. Results: Of 805 recommended medical staff (the minimum requirement for 82 health facilities), there were deficits of 539 (67%) pre-Ebola, 528 (65%) during the Ebola outbreak and 501 (62%) post-Ebola, hovering at staff shortages of >50% at all levels of health facilities. Of the 569 requisite non-medical staff, the gap remained consistent, at 92%, in the three time periods. Of the 1374 overall HCWs recommended by the BPEHS, the current staff shortage is 1026 (75%). Of 321 facility-based HCWs present during Ebola, there were 15 (14 medical and one non-medical staff) Ebola-related and three non-Ebola related deaths among HCWs. Conclusion: The post-Ebola health-related human resource deficit is alarmingly high, with very few staff available to work. We call for urgent political will, resources and international collaboration to address this situation.
    • Effect of the 2014/2015 Ebola Outbreak on Reproductive Health Services in a Rural District of Guinea: an Ecological Study

      Camara, BS; Delamou, A; Diro, E; Béavogui, AH; El Ayadi, AM; Sidibé, S; Grovogui, FM; Takarinda, KC; Bouedouno, P; Sandouno, SD; et al. (Oxford University Press, 2017-03-18)
      The 2014/2015 Ebola outbreak was the most sustained in history. In Guinea, we compared trends in family planning, antenatal care, and institutional deliveries over the period before, during and after the outbreak.
    • Fostering interest in research: evaluation of an introductory research seminar at hospitals in rural Rwanda

      Iribagiza, M K; Manikuzwe, A; Aquino, T; Amoroso, C; Zachariah, R; van Griensven, J; Schneider, S; Finnegan, K; Cortas, C; Kamanzi, E; et al. (International Union Against Tuberculosis and Lung Disease, 2014-12-21)
    • From diagnosis to case investigation for malaria elimination in Swaziland: is reporting and response timely?

      Dlamini, N; Zulu, Z; Kunene, S; Geoffroy, E; Ntshalintshali, N; Owiti, P; Sikhondze, W; Makadzange, K; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Background: Swaziland is one of the southern African countries that aim to eliminate malaria by 2020. In 2010, the country introduced an Immediate Disease Notification System (IDNS) for immediate reporting of notifiable diseases, including malaria. Health facilities are to report malaria cases within 24 h through a toll-free telephone number (977), triggering an alert for case investigation at the patient's household within 48 h. We assessed the completeness of reporting in the IDNS, the subsequent case investigation, and whether it was done within the stipulated timelines. Methods: A cross-sectional study using routine country-wide data. Results: Of 1991 malaria cases notified between July 2011 and June 2015, 76% were reported in the IDNS, of which 68% were investigated-a shortfall of 24% in reporting and 32% in case investigations. Of the 76% of cases reported through the IDNS, 62% were reported within 24 h and 20% were investigated within 48 h. These shortcomings were most pronounced in hospitals and private facilities. Investigated cases (n = 1346) were classified as follows: 60% imported, 35% local and 5% undetermined. Conclusion: The utilisation of the IDNS for case reporting to trigger investigation is crucial for active surveillance. There is a need to address the reporting and investigation gaps identified to ensure that malaria cases receive appropriate interventions.
    • High time to use rapid tests to detect multidrug resistance in sputum smear-negative tuberculosis in Belarus

      Rusovich, V; Kumar, A M V; Skrahina, A; Hurevich, H; Astrauko, A; de Colombani, P; Tayler-Smith, K; Dara, M; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2014-12-21)
    • How well are asthma treatment cards filled out in public health centres in Gazeera State, Sudan?

      Kodouda, S F; Zachariah, R; Khogali, M; van Grievensen, J; Saeed, M; Ibrahim, E H; Schneider, S; Adulazeem, S; El Sadig, H A; Atta, R; et al. (The Union, 2014-06-21)