• Body and mind: retention in antiretroviral treatment care is improved by mental health training of care providers in Ethiopia

      Berheto, TM; Hinderaker, SG; Senkoro, M; Tweya, H; Deressa, T; Getaneh, Y; Gezahegn, G (BioMed Central, 2018-07-20)
      Ethiopia has achieved a high coverage of antiretroviral treatment (ART), but maintaining lifelong care is still a great challenge. Mental illnesses often co-exist with HIV/AIDS and may compromise the retention on ART. In order to improve prolonged retention in ART care, basic training in mental health care was introduced for ART providers, but this hasn't been evaluated yet. The aim of this study was to examine if this training has improved patient retention in care.
    • Bringing care to the community: expanding access to health care in rural Malawi through mobile health clinics

      Geoffroy, E; Harries, A D; Bissell, K; Schell, E; Bvumbwe, A; Tayler-Smith, K; Kizito, W (International Union Against Tuberculosis and Lung Disease, 2014-12-21)
    • 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 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 operational research capacity in the Pacific

      Bissel, K; Viney, K; Brostrom, R; Gounder, S; Khogali, M; Kishore, K; Kool, B; Kumar, A M V; Manzi, M; Marais, B; et al. (The Union, 2014-06-21)
      Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.
    • 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.
    • The Burden of Road Traffic Injuries in an Emergency Department in Addis Ababa, Ethiopia

      Getachew, S; Ali, E; Tayler-Smith, K; Hedt-Gauthier, B; Silkondez, W; Abebe, D; Deressa, W; Enquessilase, F; Edwards, J K (International Union Against Tuberculosis and Lung Disease, 2016-06-21)
      The emergency department (ED) of Zewditu Memorial Hospital, Addis Ababa, Ethiopia.
    • Burden of Soil Transmitted Helminthiases in Primary School Children in Migori County, Kenya

      Ng'ang'a, A; Matendechero, S; Kariuki, L; Omondi, W; Makworo, N; Owiti, P; Kizito, W; Tweya, H; Edwards, JK; Takarinda, KC; et al. (African Journals Online, 2016-10)
    • Caring for patients with surgically resectable cancers: experience from a specialised centre in rural Rwanda

      Mubiligi, J M; Hedt-Gauthier, B; Mpunga, T; Tapela, N; Okao, P; Harries, A D; Edginton, M E; Driscoll, C; Mugabo, L; Riviello, R; et al. (The Union, 2014-06-21)
    • Case management of malaria in Swaziland, 2011-2015: on track for elimination?

      Dlamini, SV; Kosgei, RJ; Mkhonta, N; Zulu, Z; Makadzange, K; Zhou, S; Owiti, P; Sikhondze, W; Namboze, J; Reid, A; et al. (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Objective: To assess adherence to malaria diagnosis and treatment guidelines (2010 and 2014) in all health care facilities in Swaziland between 2011 and 2015. Methods: This was a cross-sectional descriptive study involving all health care facilities that diagnosed and managed malaria cases in Swaziland. Patients' age, sex, diagnosis method and type of treatment were analysed. Results: Of 1981 records for severe and uncomplicated malaria analysed, 56% of cases were uncomplicated and 14% had severe malaria. The type of malaria was not recorded for 30% of cases. Approximately 71% of cases were confirmed by rapid diagnostic tests (RDT) alone, 3% by microscopy alone and 26% by both RDT and microscopy. Of the uncomplicated cases, 93% were treated with artemether-lumefantrine (AL) alone, 5% with quinine alone and 2% with AL and quinine. Amongst the severe cases, 11% were treated with AL alone, 44% with quinine alone and 45% with AL and quinine. For severe malaria, clinics and health centres prescribed AL alone more often than hospitals (respectively 13%, 12% and 4%, P = 0.03). Conclusion: RDTs and/or microscopy results are used at all facilities to inform treatment. Poor recording of malaria type causes difficulties in assessing the prescription of antimalarial drugs.
    • Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

      Prasanna, T; Jeyashree, K; Chinnakali, P; Bahurupi, Y; Vasudevan, K; Das, M (Taylor & Francis Open, 2018)
      The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016-2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India.
    • Changing distribution and abundance of the malaria vector Anopheles merus in Mpumalanga Province, South Africa

      Mbokazi, F; Coetzee, M; Brooke, B; Govere, J; Reid, A; Owiti, P; Kosgei, R; Zhou, S; Magagula, R; Kok, G; et al. (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Background: The malaria vector Anopheles merus occurs in the Mpumalanga Province of South Africa. As its contribution to malaria transmission in South Africa has yet to be ascertained, an intensification of surveillance is necessary to provide baseline information on this species. The aim of this study was therefore to map An. merus breeding sites in the Ehlanzeni District of Mpumalanga Province and to assess qualitative trends in the distribution and relative abundance of this species over a 9-year period. Methods: The study was carried out during the period 2005-2014 in the four high-risk municipalities of Ehlanzeni District. Fifty-two breeding sites were chosen from all water bodies that produced anopheline mosquitoes. The study data were extracted from historical entomological records that are captured monthly. Results: Of the 15 058 Anopheles mosquitoes collected, 64% were An. merus. The abundance and distribution of An. merus increased throughout the four municipalities in Ehlanzeni District during the study period. Conclusion: The expanded distribution and increased abundance of An. merus in the Ehlanzeni District may contribute significantly to locally acquired malaria in Mpumalanga Province, likely necessitating the incorporation of additional vector control methods specifically directed against populations of this species.
    • Characteristics and Treatment Outcomes of New Pulmonary Tuberculosis Patients with Comorbidities in the Samarkand Region, Uzbekistan

      Yusupova, S; Nurullayeva, S; Sadikov, U; Gadoev, J; Alikhanova, N; Zachariak, R; Harries, A (World Health Organization, 2016-03)
    • Childhood immunization in Bungoma County, Kenya, from 2008 to 2011: need for improved uptake

      Mbuthia, G W; Harries, A D; Obala, A A; Nyamogoba, H D N; Simiyu, C; Edginton, M E; Khogali, M; Hedt-Gauthier, B L; Otsyla, B K (International Union Against Tuberculosis and Lung Disease, 2014-03)
      Uptake of immunisations in children aged 1–2 years in Bungoma County, Kenya, was determined as part of the 6-monthly Health and Demographic Surveillance System surveys. A total of 2699 children were assessed between 2008 and 2011. During this time period, full immunisation declined significantly from 84% to 58%,and measles vaccine declined uptake from 89% to 60%(P<0.001). Each year there was a significant fall-off for the third doses of the oral polio and pentavalent vaccines(P<0.001). These findings are of concern, as low immunisation coverage may lead to vaccine-preventable disease outbreaks. Further investigations into the reasons for declining immunisation trends are required.
    • 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)
    • Childhood tuberculosis in Mauritania, 2010-2015: diagnosis and outcomes in Nouakchott and the rest of the country

      Aw, B; Ade, S; Hinderaker, SG; Dlamini, N; Takarinda, KC; Chiaa, K; Feil, A; Traoré, A; Reid, T (International Union Against Tuberculosis and Lung Disease, 2017-09-21)
      Setting: The National Tuberculosis Programme, Mauritania. Objective: To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged <15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. Design: This was a retrospective comparative cohort study. Results: A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, P < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, P < 0.01) while transfers out were more common in the city (25% vs. 14%, P = 0.01). Being aged <5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. Conclusion: This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.
    • Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda

      Nyirandagijimana, B; Edwards, JK; Venables, E; Ali, E; Rusangwa, C; Mukasakindi, H; Borg, R; Fabien, M; Tharcisse, M; Nshimyiryo, A; et al. (International Union Against Tuberculosis and Lung Disease, 2017-09-21)
      Setting: Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda. Objective: We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care. Design: This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015. Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings. Conclusion: This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.
    • Comparing Yield and Relative Costs of WHO TB Screening Algorithms in Selected Risk Groups Among People Aged 65 Years and Over in China, 2013

      Zhang, C; Ruan, Y; Cheng, J; Zhao, F; Xia, Y; Zhang, H; Wilkinson, E; Das, M; Li, J; Chen, W; et al. (Public Library of Science, 2017-06-08)
      To calculate the yield and cost per diagnosed tuberculosis (TB) case for three World Health Organization screening algorithms and one using the Chinese National TB program (NTP) TB suspect definitions, using data from a TB prevalence survey of people aged 65 years and over in China, 2013.
    • Compliance to follow up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care

      Kuria, N; Reid, A; Owiti, P; Tweya, H; Kibet, CK; Mbau, L; Manzi, M; Murunga, V; Namusonge, T; Kibachio, J (Wiley-Blackwell, 2018-05-19)
      To determine and compare, among three models of care, compliance to scheduled clinic appointments and adherence to anti-hypertensive medication of patients in an informal settlement of Kibera, Kenya.
    • Conflict and tuberculosis in Sudan: a 10-year review of the National Tuberculosis Programme, 2004-2014.

      Hassanain, SA; Edwards, JK; Venables, E; Ali, E; Adam, K; Hussien, H; Elsony, A (BioMed Central, 2018-05-16)
      Sudan is a fragile developing country, with a low expenditure on health. It has been subjected to ongoing conflicts ever since 1956, with the Darfur crisis peaking in 2004. The conflict, in combination with the weak infrastructure, can lead to poor access to healthcare. Hence, this can cause an increased risk of infection, greater morbidity and mortality from tuberculosis (TB), especially amongst the poor, displaced and refugee populations. This study will be the first to describe TB case notifications, characteristics and outcomes over a ten-year period in Darfur in comparison with the non-conflict Eastern zones within Sudan.