• 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; Park, PH; Raviola, GJ; Smith, SL (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; Hu, D; Jeyashree, K; Wang, L (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.
    • 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; Kapur, A; Shaikh, I; Seita, A (International Union Against Tuberculosis and Lung Disease, 2014-03-25)
    • Did microbial larviciding contribute to a reduction in malaria cases in eastern Botswana in 2012-2013?

      Obopile, M; Segoea, G; Waniwa, K; Ntebela, DS; Moakofhi, K; Motlaleng, M; Mosweunyane, T; Edwards, JK; Namboze, J; Butt, W; Manzi, M; Takarinda, KC; Owiti, P (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Setting: Larviciding has potential as a component of integrated vector management for the reduction of malaria transmission in Botswana by complementing long-lasting insecticide nets and indoor residual sprays. Objective: To evaluate the susceptibility of local Anopheles to commonly used larvicides. Design: This field test of the efficacy of Bacillus thuringiensis subsp. israliensis vs. Anopheles was performed by measuring larval density before treatment and 24 h and 48 h after treatment in seven sites of Bobirwa district, eastern Botswana, in 2012 and 2013. Vector density and malaria cases were compared between Bobirwa and Ngami (northwestern Botswana), with no larviciding in the control arm. Results: Larviciding reduced larval density by 95% in Bobirwa in 2012, with two cases of malaria, while in 2013 larval density reduction was 81%, with 11 cases. Adult mosquito density was zero for both years in Robelela village (Bobirwa), compared to respectively four and 26 adult mosquitoes per room in Shorobe village (Ngami) in 2012 and 2013. There were no cases of malaria in Robelela in either year, but in Shorobe there were 20 and 70 cases, respectively, in 2012 and 2013. Conclusion: Larviciding can reduce the larval density of mosquitoes and reduce malaria transmission in Botswana. Large-scale, targeted implementation of larviciding in districts at high risk for malaria is recommended.
    • Different Challenges, Different Approaches and Related Expenditures of Community-Based Tuberculosis Activities by International Non-Governmental Organizations in Myanmar

      Han, WW; Saw, S; Isaakidis, P; Khogali, M; Reid, A; Hoa, N; Zaw, KK; Aung, ST (BioMed Central, 2017-03-24)
      International non-governmental organizations (INGOs) have been implementing community-based tuberculosis (TB) care (CBTBC) in Myanmar since 2011. Although the National TB Programme (NTP) ultimately plans to take over CBTBC, there have been no evaluations of the models of care or of the costs of providing CBTBC in Myanmar by INGOs.
    • Do incentives improve tuberculosis treatment outcomes in the Republic of Moldova?

      Ciobanu, A; Domente, L; Soltan, V; Bivol, S; Severin, L; Plesca, V; Van den Bergh, R; Kumar, A M V; de Colombani, P (International Union Against Tuberculosis and Lung Disease, 2014-10-21)
    • 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 an Isoniazid Prophylaxis Register Improve Tuberculosis Contact Management in South African Children?

      van Soelen, N; du Preez, K; van Wyk, S S; Mandalakas, A M; Enarson, D A; Reid, A J; Hesseling, A C (Public Library of Science, 2013)
      We compared the change in child household contact management of pulmonary tuberculosis (TB) cases before and after the implementation of an isoniazid preventive therapy (IPT) register in an urban clinic setting in Cape Town, South Africa.
    • 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.
    • 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; Oumer, N; Mosweunyane, T (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.
    • Early Physical and Functional Rehabilitation of Trauma Patients in the Médecins Sans Frontières Trauma Centre in Kunduz, Afghanistan: Luxury or Necessity?

      Gohy, B; Ali, E; Van den Bergh, R; Schillberg, E; Nasim, M; Naimi, MM; Cheréstal, S; Falipou, P; Weerts, E; Skelton, P; Van Overloop, C; Trelles, M (Oxford University Press, 2016-10-13)
      In Afghanistan, Médecins Sans Frontières provided specialised trauma care in Kunduz Trauma Centre (KTC), including physiotherapy. In this study, we describe the development of an adapted functional score for patient outcome monitoring, and document the rehabilitation care provided and patient outcomes in relation to this functional score.
    • 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 Previous Utilization and Out-Of-Pocket Expenditure on Subsequent Utilization of a State Led Public-Private Partnership Scheme "Chiranjeevi Yojana" to Promote Facility Births in Gujarat, India

      Yasobant, S; Shewade, HD; Vora, KS; Annerstedt, KS; Isaakidis, P; Dholakia, NB; Mavalankar, DV (BioMed Central, 2017-04-25)
      In Gujarat, India, a state led public private partnership scheme to promote facility birth named Chiranjeevi Yojana (CY) was implemented in 2005. Institutional birth is provided free of cost at accredited private health facilities to women from socially disadvantaged groups (eligible women). CY has contributed in increasing facility birth and providing substantially subsidized (but not totally free) birth care; however, the retention of mothers in this scheme in subsequent child birth is unknown. Therefore, we conducted a study aimed to determine the effect of previous utilization of the scheme and previous out of pocket expenditure on subsequent child birth among multiparous eligible women in Gujarat.
    • 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; Okumura, J; Baldé, MD; Van Griensven, J; Zachariah, R (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.
    • Effects of the 2014 Ebola outbreak on antenatal care and delivery outcomes in Liberia: a nationwide analysis

      Shannon, FQ; Horace-Kwemi, E; Najjemba, R; Owiti, P; Edwards, J; Shringarpure, K; Bhat, P; Kateh, F N (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: All health facilities, public and private, in Liberia, West Africa. Objectives: To determine access to antenatal care (ANC), deliveries and their outcomes before, during and after the 2014-2015 Ebola outbreak. Design: This was a descriptive cross-sectional study. Result: During the Ebola outbreak in Liberia, overall monthly reporting from health facilities plunged by 43%. Access to ANC declined by 50% and reported deliveries fell by one third during the outbreak. Reported deliveries by skilled attendants and Caesarian section declined by respectively 32% and 60%. Facility-based deliveries dropped by 35% and reported community deliveries fell by 47%. There was an overall decline in reported stillbirths, maternal and neonatal deaths, by 50%, during the outbreak. ANC, reported deliveries and related outcomes returned to pre-outbreak levels within one year following the outbreak. Conclusion: The Liberian health system was considerably weakened during the Ebola outbreak and had difficulties providing basic maternal health services. In the light of the major reporting gaps during the Ebola period, and the reduced use of health facilities for maternal care, these findings highlight the need for measures to avoid such disruptions during future outbreaks.
    • Engagement of Public and Private Medical Facilities in Tuberculosis Care in Myanmar: Contributions and Trends Over an Eight-Year Period

      Nwe, T; Saw, S; Le Win, L; Mon, M; van Griensven, J; Zhou, S; Chinnakali, P; Shah, S; Thein, S; Aung, S (BioMed Central, 2017-09-01)
      As part of the WHO End TB strategy, national tuberculosis (TB) programs increasingly aim to engage all private and public TB care providers. Engagement of communities, civil society organizations and public and private care provider is the second pillar of the End TB strategy. In Myanmar, this entails the public-public and public-private mix (PPM) approach. The public-public mix refers to public hospital TB services, with reporting to the national TB program (NTP). The public-private mix refers to private general practitioners providing TB services including TB diagnosis, treatment and reporting to NTP. The aim of this study was to assess whether PPM activities can be scaled-up nationally and can be sustained over time.