A Qualitative Study Investigating Experiences, Perceptions, and Healthcare System Performance in Relation to the Surveillance of Typhoid Fever in Madagascar

Pach, Alfred; Warren, Michelle R.; Chang, Irene; Im, Justin; Nichols, Chelsea; Meyer, Christian G.; Pak, Gi Deok; Panzner, Ursula; Park, Se Eun; Kalckreuth, Vera von; Baker, Stephen; Rabezanahary, Henintsoa; Raminosoa, Tiana Mirana; Rakotozandrindrainy, Raphäel; Marks, Florian

doi:10.1093/cid/civ892

Cited by 12 publications

(10 citation statements)

References 16 publications

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“…More than half the Malagasy population live further than 5 km (roughly corresponding to an hour’s walk) from their nearest health facility. This likely contributes substantially to the treatment-seeking rate that ranged in 2013 from 21.7 to 49.1 % across different parts of the country [ 24 , 43 , 50 , 51 ], with many patients suffering fevers resorting to self-medication instead (including both pharmaceutical and traditional herbal remedies) [ 52 ]. Therefore, most cases of fever will never interact with the country’s formal health system.…”

Section: Discussionmentioning

confidence: 99%

Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning

Howes

Mioramalala

Ramiranirina³

et al. 2016

Malar J

108

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BackgroundMalaria remains a major public health problem in Madagascar. Widespread scale-up of intervention coverage has led to substantial reductions in case numbers since 2000. However, political instability since 2009 has disrupted these efforts, and a resurgence of malaria has since followed. This paper re-visits the sub-national stratification of malaria transmission across Madagascar to propose a contemporary update, and evaluates the reported routine case data reported at this sub-national scale.MethodsTwo independent malariometrics were evaluated to re-examine the status of malaria across Madagascar. First, modelled maps of Plasmodium falciparum infection prevalence (PfPR) from the Malaria Atlas Project were used to update the sub-national stratification into ‘ecozones’ based on transmission intensity. Second, routine reports of case data from health facilities were synthesized from 2010 to 2015 to compare the sub-national epidemiology across the updated ecozones over time. Proxy indicators of data completeness are investigated.ResultsThe epidemiology of malaria is highly diverse across the island’s ecological regions, with eight contiguous ecozones emerging from the transmission intensity PfPR map. East and west coastal areas have highest transmission year-round, contrasting with the central highlands and desert south where trends appear more closely associated with epidemic outbreak events. Ecozones have shown steady increases in reported malaria cases since 2010, with a near doubling of raw reported case numbers from 2014 to 2015. Gauges of data completeness suggest that interpretation of raw reported case numbers will underestimate true caseload as only approximately 60–75 % of health facility data are reported to the central level each month.DiscussionA sub-national perspective is essential when monitoring the epidemiology of malaria in Madagascar and assessing local control needs. A robust assessment of the status of malaria at a time when intervention coverage efforts are being scaled up provides a platform from which to guide intervention preparedness and assess change in future periods of transmission.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1556-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning

Howes

Mioramalala

Ramiranirina³

et al. 2016

Malar J

108

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“…The cataract operation TDABC model was the most complex and proved the most valuable in determining cost drivers, improving efficiency and increasing patient revenue [9]. Information from the model helped Sava increase fees from patients who came directly to the hospital (as opposed to those referred from outreach camps and had free surgery) in excess of the cost of their cataract operations.…”

Section: Discussionmentioning

confidence: 99%

Achieving self-sustainability of service delivery in an eye care program in Madagascar using time-driven activity based costing

Rakotondrajoa

Rakotomamonjy

Baptiste

et al. 2020

BMC Health Serv Res

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Background: In the absence of adequate and reliable external funding, eye care programs in developing countries need a high level of financial self-sustainability for maintenance and growth. To cope with these cost pressures, an eye care program in Sava, Madagascar adopted a Time-Driven Activity Based Costing (TDABC) methodology to better manage the cost of, and to improve revenue associated with, their three principle activities: consultation visits, cataract operations, and sale of glasses. Methods: Direct (variable) and indirect (fixed) cost estimates and revenue sources were gathered by activity (consultation, cataract operation, sale of glasses) and location (hospital or outreach) and TDABC models were established. Estimates were made of the proportion of the ophthalmologist's time (by far the scarcest and most expensive resource) dedicated to consultation, cataract operation, or sale of glasses. These proportions were used to attribute costs by activity. The hospital manager and medical director modified staff roles, program activities, and infrastructure investments to reduce costs and expand revenue sources by activity while monitoring activity specific efficiency and profit.

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“…Another limitation is due to the inclusion of mainly patients aged below 15 years overestimating pathogens prevalent in children. However, this age imbalance reflects the true demographics of patients attending health care in Madagascar, where socioeconomic status, travel distance to the facilities and care utilization largely influence healthcare-seeking behavior[ 43 , 44 ]. Nevertheless, the results of our study draw an overview of most prevalent pathogens associated with fever in the country and provide relevant information for further investigations.…”

Section: Discussionmentioning

confidence: 99%

Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar

Guillebaud

Bernardson

Randriambolamanantsoa

et al. 2018

PLoS Negl Trop Dis

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BackgroundThe increasing use of malaria diagnostic tests reveals a growing proportion of patients with fever but no malaria. Clinicians and health care workers in low-income countries have few tests to diagnose causes of fever other than malaria although several diseases share common symptoms. We propose here to assess etiologies of fever in Madagascar to ultimately improve management of febrile cases.MethodologyConsenting febrile outpatients aged 6 months and older were recruited in 21 selected sentinel sites throughout Madagascar from April 2014 to September 2015. Standard clinical examinations were performed, and blood and upper respiratory specimens were taken for rapid diagnostic tests and molecular assays for 36 pathogens of interest for Madagascar in terms of public health, regardless of clinical status.Principal findingsA total of 682 febrile patients were enrolled. We detected at least one pathogen in 40.5% (276/682) of patients and 6.2% (42/682) with co-infections. Among all tested patients, 26.5% (181/682) had at least one viral infection, 17.0% (116/682) had malaria and 1.0% (7/682) presented a bacterial or a mycobacterial infection. None or very few of the highly prevalent infectious agents in Eastern Africa and Asia were detected in this study, such as zoonotic bacteria or arboviral infections.ConclusionsThese results raise questions about etiologies of fever in Malagasy communities. Nevertheless, we noted that viral infections and malaria still represent a significant proportion of causes of febrile illnesses. Interestingly our study allowed the detection of pathogens of public health interest such as Rift Valley Fever Virus but also the first case of laboratory-confirmed leptospirosis infection in Madagascar.

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A Qualitative Study Investigating Experiences, Perceptions, and Healthcare System Performance in Relation to the Surveillance of Typhoid Fever in Madagascar

Cited by 12 publications

References 16 publications

Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning

Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning

Achieving self-sustainability of service delivery in an eye care program in Madagascar using time-driven activity based costing

Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar

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