BackgroundHealth workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs.ObjectiveThis study evaluates communities’ perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field.MethodsThe study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers.ResultsCommunities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage.ConclusionThis study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.

Background Coronavirus disease-2019 (COVID-19), a pandemic that brought the whole world to a standstill, has led to financial and health care burden. We aimed to evaluate epidemiological characteristics, needs of resources, outcomes, and global burden of the disease. Methods Systematic review was performed searching PubMed from December 1, 2019, to March 25, 2020, for full-text observational studies that described epidemiological characteristics, following MOOSE protocol. Global data were collected from the JHU-Corona Virus Resource Center, WHO-COVID-2019 situation reports, KFF.org, and Worldometers.info until March 31, 2020. The prevalence percentages were calculated. The global data were plotted in excel to calculate case fatality rate (CFR), predicted CFR, COVID-19 specific mortality rate, and doubling time for cases and deaths. CFR was predicted using Pearson correlation, regression models, and coefficient of determination. Results From 21 studies of 2747 patients, 8.4% of patients died, 20.4% recovered, 15.4% were admitted to ICU and 14.9% required ventilation. COVID-19 was more prevalent in patients with hypertension (19.3%), smoking (11.3%), diabetes mellitus (10%), and cardiovascular diseases (7.4%). Common complications were pneumonia (82%), cardiac complications (26.4%), acute respiratory distress syndrome (15.7%), secondary infection (11.2%), and septic shock (4.3%). Though CFR and COVID-19 specific death rates are dynamic, they were consistently high for Italy, Spain, and Iran. Polynomial growth models were best fit for all countries for predicting CFR. Though many interventions have been implemented, stern measures like nationwide lockdown and school closure occurred after very high infection rates (>10cases per 100 000population) prevailed. Given the trend of government measures and decline of new cases in China and South Korea, most countries will reach the peak between April 1-20, if interventions are followed. Conclusions A collective approach undertaken by a responsible government, wise strategy implementation and a receptive population may help contain the spread of COVID-19 outbreak. Close monitoring of predictive models of such indicators in the highly affected countries would help to evaluate the potential fatality if the second wave of pandemic occurs. The future studies should be focused on identifying accurate indicators to mitigate the effect of underestimation or overestimation of COVID-19 burden.

By documenting widespread use of mobile phones and health worker perceptions of their most useful applications, this paper provides a framework for their integration into the community case management of malaria programme in Saraya, Senegal.

BackgroundThe objective of this project was to achieve high, sustainable levels of net coverage in a village in rural Tanzania by combining free distribution of long-lasting insecticide-impregnated nets (LLINs) with community-tailored education. In Tanzania, malaria is the leading cause of morbidity and mortality. Although malaria bed nets have a well-established role in reducing disease burden, few rural households have access to nets, and effective use depends on personal practices and attitudes.MethodsFive practices and attitudes inconsistent with effective LLIN use were identified from household interviews (n = 10). A randomized survey of villagers (n = 132) verified local prevalence of these practices and attitudes. Community leaders held an educational session for two members of every household addressing these practice and attitudes, demonstrating proper LLIN use, and emphasizing behaviour modification. Attendees received one or two LLINs per household. Surveys distributed three weeks (n = 104) and 15 months (n = 104) post-intervention assessed corrected practices and attitudes. Project efficacy was defined by correction of baseline practices and attitudes as well as high rates of reported daily net use, with statistical significance determined by chi-square test.ResultsBaseline interviews and surveys revealed incorrect practices and attitudes regarding 1) use of nets in dry season, 2) need to retreat LLINs, 3) children napping under nets, 4) need to repair nets, and 5) net procurement as a priority, with 53- 88.6% incorrect responses (11.4-47% correct responses). A three-week follow-up demonstrated 83-95% correct responses. Fifteen-month follow-up showed statistically significant (p < 0.01) corrections from baseline in all five practice and attitudes (39.4-93.3% correct answers). 89.4% of respondents reported using their nets every night, and 93.3% affirmed purchase of nets as a financial priority.ConclusionsResults suggest that addressing community-specific practices and attitudes prior to LLIN distribution promotes consistent and correct use, and helps change attitudes towards bed nets as a preventative health measure. Future LLIN distributions can learn from the paradigm established in this project.

The Mount Sinai Global Health Center established a new multidisciplinary Global Health Residency Track (GHRT) in 2006. The goal of the GHRT is to provide participants with a foundation in global health issues and population-based health care, a chance to develop basic research and public health skills in the field, and guidance for career development. The authors describe how the GHRT was created, present its structure, and discuss their experience implementing this new program. Other selected global health residency training programs are also reviewed. The Mount Sinai GHRT is a two-year program that comprises a didactic curriculum, with participants required to take selected classes in the Master of Public Health Program of the Mount Sinai School of Medicine of New York University, and "field experience," which consists of a public health project that is implemented during a two-month elective period during the second year. Core competencies include (1) epidemiology and research skills, (2) health disparities, human rights, and cultural competency, (3) needs assessment and project development, (4) tropical medicine and infectious disease, and (5) reproductive, maternal, and child health. Nine residents were selected from four Mount Sinai residency programs to participate in the GHRT in its first year, and, during the winter of 2007, senior residents conducted public health projects in the Dominican Republic, India, Kenya, and East Harlem. All components of the track performed well in evaluations. An outcomes survey is ongoing to track career choices among graduates and to identify barriers to continuing involvement in global health.

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BackgroundWhile the distribution of mosquito bed nets is a widely adopted approach for malaria prevention, studies exploring how the usage of a net may be influenced by its source and other factors remain sparse.MethodsA standardized questionnaire and home-visit observations were used to collect data from 9 villages in Budondo sub-county, Uganda in 2016. Household- and individual-level data were collected, such as bed net ownership (at least one net versus none), acquirement source (free versus purchased), demographics, as well as knowledge of malaria and preventative measures. Net-level data, including alternative uses, and bed net quantity and integrity, were also collected. Mixed effects logistic regression models were performed to identify the key determinants of bed net use.ResultsOverall, the proportion of households with at least one bed net was 40%, while bed net availability was only reported among 27% of all household members. Awareness of the benefits of bed net use was statistically significantly associated with ownership of at least one net (OR = 1.72, 95% CI 1.11–2.68, p = 0.02). Among those who own net(s), the odds of a bed net being correctly used (i.e., to sleep under) after adjusting for potential confounders were significantly lower for nets that were obtained free compared to nets that were purchased by the owners themselves (OR = 0.33, 95% CI 0.21–0.51, p < 0.01), resulting in an alternative use of the net. Other factors such as female gender, children ≤ 5 years old, and pregnancy status were also significantly associated with having a net to sleep under (all p < 0.01).ConclusionUnderstanding inter- and intra-household net-use factors will help malaria control programmes more effectively direct their efforts to increase public health impact. Future studies may additionally consider socioeconomic status and track the lifetime of the net.

Background With the federal scale-up of antiretroviral therapy (ART) in Ethiopia, survival and quality of life for people with HIV/AIDS has increased. However, some patients do not respond to ART. Failure to suppress viral replication leads to increased morbidity and mortality, making early diagnosis of treatment failure imperative for the reduction of negative outcomes for patients. In this quality improvement project, we aimed to fi nd predictors of treatment failure that can be used, with clinical and immunological monitoring, to guide diagnosis of fi rst-line ART failure. MethodsWe undertook a retrospective chart review and analysed baseline characteristics of 55 male and female patients, aged 2-54 years, on second-line ART and 55 control patients matched for age, gender, and treatment who continued to respond to fi rst-line ART at the World Wide Orphans/AIDS Healthcare Foundation (WWO/AHF) Family Health Clinic in Addis Ababa, Ethiopia. We used bivariate analyses, and included signifi cant variables in logistic regression modelling. Findings Three factors were signifi cant predictors of treatment failure: the presence of at least 1 month of fair or poor adherence (OR 15•7, 95% CI 1•8-136•7; p=0•01); previous treatment at another clinic before the WWO/AHF Family Health Clinic (1•4, 1•2-13•7; p=0•02); and tuberculosis symptoms at baseline (3•6, 1•1-12•3; p=0•04). In adult patients (n=58), two separate factors were signifi cant predictors of treatment failure: non-use of soft drugs, such as marijuana and khat (0•02, 0•001-0•445; p=0•02), and low baseline CD4 count (0•985, 0•972-0•999; p=0•03) Interpretation Predictors of ART failure can be used for early identifi cation of patients at high risk of fi rst-line treatment failure. Subsequent rapid transition to second-line therapy could result in better outcomes and care for these patients at the WWO/AHF Family Health Clinic in Addis Ababa, Ethiopia. The association between non-use of soft drugs and failure of fi rst-line ART should be explored further.