Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study

Ajayi, IkeOluwapo O.; Jegede, Ayodele S.; Falade, Catherine O.; Sommerfeld, Johannes

doi:10.1186/2049-9957-2-25

Cited by 30 publications

(54 citation statements)

References 9 publications

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“…These results are consistent with the previously described negative associations between malaria and socioeconomic status [38–41]. Disease persistence decreases with increasing employment, literacy and income S1 Fig 9, with poor people more vulnerable to ineffective diagnosis and treatment for financial and cultural reasons, and less able to access antimalarial and anti-mosquito protection [42]. Consistent results for Plasmodium falciparum emphasize the driven nature of the patterns.…”

Section: Discussionsupporting

confidence: 89%

Population Density, Climate Variables and Poverty Synergistically Structure Spatial Risk in Urban Malaria in India

et al. 2016

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BackgroundThe world is rapidly becoming urban with the global population living in cities projected to double by 2050. This increase in urbanization poses new challenges for the spread and control of communicable diseases such as malaria. In particular, urban environments create highly heterogeneous socio-economic and environmental conditions that can affect the transmission of vector-borne diseases dependent on human water storage and waste water management. Interestingly India, as opposed to Africa, harbors a mosquito vector, Anopheles stephensi, which thrives in the man-made environments of cities and acts as the vector for both Plasmodium vivax and Plasmodium falciparum, making the malaria problem a truly urban phenomenon. Here we address the role and determinants of within-city spatial heterogeneity in the incidence patterns of vivax malaria, and then draw comparisons with results for falciparum malaria.Methodology/principal findingsStatistical analyses and a phenomenological transmission model are applied to an extensive spatio-temporal dataset on cases of Plasmodium vivax in the city of Ahmedabad (Gujarat, India) that spans 12 years monthly at the level of wards. A spatial pattern in malaria incidence is described that is largely stationary in time for this parasite. Malaria risk is then shown to be associated with socioeconomic indicators and environmental parameters, temperature and humidity. In a more dynamical perspective, an Inhomogeneous Markov Chain Model is used to predict vivax malaria risk. Models that account for climate factors, socioeconomic level and population size show the highest predictive skill. A comparison to the transmission dynamics of falciparum malaria reinforces the conclusion that the spatio-temporal patterns of risk are strongly driven by extrinsic factors.Conclusion/significanceClimate forcing and socio-economic heterogeneity act synergistically at local scales on the population dynamics of urban malaria in this city. The stationarity of malaria risk patterns provides a basis for more targeted intervention, such as vector control, based on transmission ‘hotspots’. This is especially relevant for P. vivax, a more resilient parasite than P. falciparum, due to its ability to relapse and the operational shortcomings of delivering a “radical cure”.

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Section: Discussionsupporting

confidence: 89%

Population Density, Climate Variables and Poverty Synergistically Structure Spatial Risk in Urban Malaria in India

et al. 2016

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“…Although there was no consensus on what financial strategies would be practical to sustain the program, there was agreement that incentives were essential, although strategies in one country may not be relevant elsewhere. While many suggested monetary incentives, others considered that nonmonetary incentives such as special recognition by their communities would be an important beginning to reduce CHW attrition rates [5, 21]. …”

Section: Discussionmentioning

confidence: 99%

“…There is evidence that deploying artemisinin-based combination therapies (ACTs) and rectal artesunate at the community level using trained lay community members is feasible, effective, and saves lives [5, 6]. The use of RDTs in the community setting is increasing but far less studied [3, 7–11].…”

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confidence: 99%

Assessing Acceptability of a Diagnostic and Malaria Treatment Package Delivered by Community Health Workers in Malaria-Endemic Settings of Burkina Faso, Nigeria, and Uganda

Jegede¹,

Oshiname²,

Sanou³

et al. 2016

Clin Infect Dis.

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Background. The efficacy of artemisinin-based combination therapy (ACT) and rectal artesunate for severe malaria in children is proven. However, acceptability of a package of interventions that included use of malaria rapid diagnostic tests (RDTs), ACTs, and rectal artesunate when provided by community health workers (CHWs) is uncertain. This study assessed acceptability of use of CHWs for case management of malaria using RDTs, ACTs, and rectal artesunate.Methods. The study was carried out in Burkina Faso, Nigeria, and Uganda in 2015 toward the end of an intervention using CHWs to provide diagnosis and treatment. Focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with parents of sick children, community leaders, and health workers to understand whether they accepted the package for case management of malaria using CHWs. Transcripts from FGDs and KII recordings were analyzed using content analysis. The findings were described, interpreted, and reported in the form of narratives.Results. Treatment of malaria using the CHWs was acceptable to caregivers and communities. The CHWs were perceived to be accessible, diligent, and effective. There were no physical, social, or cultural barriers to accessing the CHWs’ services. Respondents were extremely positive about the intervention and were concerned that CHWs had limited financial and nonfinancial incentives that would reduce their motivation and willingness to continue.Conclusions. Treatment of malaria using CHWs was fully accepted. CHWs should be compensated, trained, and well supervised.Clinical Trials Registration. ISRCTN13858170.

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“…the CDTI strategy and expansion of the strategy for delivery of other health interventions. Implementation research also provided the basis for todays strategy of home management of malaria (Horstick et al., 2010, Ajayi et al., 2013, Brieger et al., 2015, Sommerfeld et al., 2015). An implementation research tool kit is available http://www.who.int/tdr/publications/topics/ir-toolkit/en/(accessed 16 January 2016).…”

Section: Introductionmentioning

confidence: 99%

Research for new drugs for elimination of onchocerciasis in Africa

Kuesel

2016

International Journal for Parasitology: Drugs and Drug Resistan

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Onchocerciasis is a parasitic, vector borne disease caused by the filarial nematode Onchocerca volvulus. More than 99% of the population at risk of infection live in Africa. Onchocerciasis control was initiated in West Africa in 1974 with vector control, later complemented by ivermectin mass drug administration and in the other African endemic countries in 1995 with annual community directed treatment with ivermectin (CDTI.) This has significantly reduced infection prevalence. Together with proof-of-concept for onchocerciasis elimination with annual CDTI from foci in Senegal and Mali, this has resulted in targeting onchocerciasis elimination in selected African countries by 2020 and in 80% of African countries by 2025. The challenges for meeting these targets include the number of endemic countries where conflict has delayed or interrupted control programmes, cross-border foci, potential emergence of parasite strains with low susceptibility to ivermectin and co-endemicity of loiasis, another parasitic vector borne disease, which slows down or prohibits CDTI implementation. Some of these challenges could be addressed with new drugs or drug combinations with a higher effect on Onchocerca volvulus than ivermectin. This paper reviews the path from discovery of new compounds to their qualification for large scale use and the support regulatory authorities provide for development of drugs for neglected tropical diseases. The status of research for new drugs or treatment regimens for onchocerciasis along the path to regulatory approval and qualification for large scale use is reviewed. This research includes new regimens and combinations of ivermectin and albendazole, antibiotics targeting the O. volvulus endosymbiont Wolbachia, flubendazole, moxidectin and emodepside and discovery of new compounds.

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Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study

Cited by 30 publications

References 9 publications

Population Density, Climate Variables and Poverty Synergistically Structure Spatial Risk in Urban Malaria in India

Population Density, Climate Variables and Poverty Synergistically Structure Spatial Risk in Urban Malaria in India

Assessing Acceptability of a Diagnostic and Malaria Treatment Package Delivered by Community Health Workers in Malaria-Endemic Settings of Burkina Faso, Nigeria, and Uganda

Research for new drugs for elimination of onchocerciasis in Africa

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